The International Liaison Committee on Resuscitation (ILCOR) develops evidence-informed recommendations for resuscitation and first aid through a structured and transparent evidence evaluation process. This 2025 methodological statement describes the frameworks used to generate Consensus on Science with Treatment Recommendations (CoSTR), emphasizing systematic rigor, transparency, and conflict-of-interest (COI) management. Clinical questions are prioritized according to relevance, uncertainty, and potential impact, then formulated using PICOST methodology. Evidence evaluations are conducted through systematic reviews, scoping reviews, evidence updates, and adolopment processes, following PRISMA and GRADE guidance. Searches are performed across multiple databases, with predefined inclusion criteria, duplicate screening, standardized risk-of-bias assessment, and evidence synthesis using GRADE evidence profiles and evidence-to-decision frameworks. Treatment recommendations are categorized according to strength and certainty of evidence, while good practice statements are used when direct evidence is limited but guidance remains necessary and actionable. Draft CoSTRs undergo public comment before final publication and subsequent adoption by international guideline-writing organizations. The statement also details ILCOR’s comprehensive COI management strategy. All participants disclose commercial and intellectual conflicts, with continuous oversight by task force chairs and dedicated COI committees. Measures include reassignment of reviewers, abstention from voting, and transparent publication of disclosures. Emerging methodological developments, including network meta-analysis, Bayesian analysis, and artificial intelligence-assisted evidence evaluation, are discussed as future opportunities to enhance efficiency and rigor. Overall, the document highlights ILCOR’s commitment to trustworthy, globally relevant resuscitation guidance.
Morley, P. T., Berg, K. M., Billi, J. E., Nolan, J. P., Montgomery, W. H., Atkins, D. L., Bray, J. E., Carlson, J. N., De Caen, A. R., Djarv, T., Drennan, I. R., Greif, R., Lavonas, E. J., Liley, H. G., Lockey, A. S., Maconochie, I., Neumar, R. W., Olasveengen, T. M., Orkin, A. M., Perkins, G. D., Rabi, Y., Sandroni, C., Schmolzer, G. M., Scholefield, B. R., Singletary, E. M., Welsford, M., Yeung, J., Morrison, L. J., Methodology and Conflict of Interest Management: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations, <<CIRCULATION>>, 2025; 152 (16): S23-S33. [doi:10.1161/CIR.0000000000001366] [https://hdl.handle.net/10807/337559]
Methodology and Conflict of Interest Management: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations
Sandroni, ClaudioWriting – Review & Editing
;
2025
Abstract
The International Liaison Committee on Resuscitation (ILCOR) develops evidence-informed recommendations for resuscitation and first aid through a structured and transparent evidence evaluation process. This 2025 methodological statement describes the frameworks used to generate Consensus on Science with Treatment Recommendations (CoSTR), emphasizing systematic rigor, transparency, and conflict-of-interest (COI) management. Clinical questions are prioritized according to relevance, uncertainty, and potential impact, then formulated using PICOST methodology. Evidence evaluations are conducted through systematic reviews, scoping reviews, evidence updates, and adolopment processes, following PRISMA and GRADE guidance. Searches are performed across multiple databases, with predefined inclusion criteria, duplicate screening, standardized risk-of-bias assessment, and evidence synthesis using GRADE evidence profiles and evidence-to-decision frameworks. Treatment recommendations are categorized according to strength and certainty of evidence, while good practice statements are used when direct evidence is limited but guidance remains necessary and actionable. Draft CoSTRs undergo public comment before final publication and subsequent adoption by international guideline-writing organizations. The statement also details ILCOR’s comprehensive COI management strategy. All participants disclose commercial and intellectual conflicts, with continuous oversight by task force chairs and dedicated COI committees. Measures include reassignment of reviewers, abstention from voting, and transparent publication of disclosures. Emerging methodological developments, including network meta-analysis, Bayesian analysis, and artificial intelligence-assisted evidence evaluation, are discussed as future opportunities to enhance efficiency and rigor. Overall, the document highlights ILCOR’s commitment to trustworthy, globally relevant resuscitation guidance.
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