May we ask you for a short introduction?
I work as a deputy consultant doctor at the High Dependency Care Unit for Children at the Hořovice Hospital and also as an assistant professor at the Department of Paediatric Anaesthesiology and Resuscitation of the FM MU and the University Hospital in Brno. I am a paediatrician and I focus mainly on paediatric intensive care. I have been working in the Czech Resuscitation Council Committee and in the Committee for Science and Education of the European Resuscitation Council for several years. I lead basic and advanced resuscitation courses of the Czech and European Resuscitation Council and instructor courses in the Czech Republic and abroad.
As one of two co-authors from the Czech Republic, you participated in the ERC guidelines for resuscitation. In addition, you are the first in the history of FM MU to work on this important document. Can you tell us what it is? How is this document important?
From the Czech Republic, MUDr. Anatolij Truhlář, Ph.D., FERC, Chair of the Czech Resuscitation Council is also a co-author of the section on cardiac arrest under specific circumstances. Guidelines, or recommended practices, are a document issued by the European Resuscitation Council (ERC) every 5 years and is a recommendation on how to proceed in cases of cardiac arrest and other critical conditions that may result in cardiac arrest. This document is based on available studies, meta-analyses, guidelines of other associations and other evidence, which it critically describes and evaluates (using standardised tools and procedures - GRADE, AMSTAR2, AGREE2). It also analyses areas where we lack evidence for certain procedures (see evidence gaps). However, it is not only a statement of records, it also deals with the fact that the recommendations could be used in education and implemented in existing practice. The result is an extensive document of several hundred pages with a number of attachments. The whole document would probably not have a large number of readers, therefore it is divided into several parts, of which the most important part is the Concise guidelines for clinical practice (i.e. brief recommendations for clinical practice) for most of the clinical personnel. These basically determine the procedure that we believe will most likely lead to success in a certain situation for a given group of patients (adults, children, new-borns after childbirth, in the operating room, etc.). The procedure in accordance with these recommendations can therefore be considered as "lege artis". Of course, the health care provider may decide to proceed differently from the recommended procedures in a particular patient, but in this case they should very carefully document how and especially why they deviated from these procedures, as the recommended procedures can be perceived as a standard in the legal perspective within Europe.
How did you manage to get involved with the team that prepared the guidelines?
I had been working in the field of education for several years before. Together with other members of the Czech Resuscitation Council Committee, as well as other collaborators, in the Czech Republic we began teaching basic and advanced resuscitation courses of the European Resuscitation Council, which are accredited in many countries of the European Union and Great Britain, but also in some non-European countries. I helped to launch the European Paediatric Advanced Life Support courses in Romania, Sweden, Finland and Ukraine, for example. In countries where these courses have a longer tradition, they are normally a mandatory part of the pre-certification training of doctors and education of other non-medical health professionals. When the European Resuscitation Council announced a selection procedure for the Science and Education Committee for Paediatric Life Support, I submitted an application at the initiative of the CRC Chair and was selected to the committee in 2017. A team of guidelines authors was established through this committee, although not all committee members are authors at the same time. The work on guidelines logically follows up on other activities that the individual committees have been dealing with long-term. In addition to the guidelines for resuscitation of children, I was also selected as a representative for the paediatric group to join the team that dealt with ethics and decision-making at the end of life, which is also an area that is close to me.
How would you evaluate the quality of education in the Czech Republic in this area?
Education in the field of resuscitation is certainly moving forward, but the current situation is far from the ideal. Above all, there are large differences between individual facilities in terms of the intensity and quality of various resuscitation courses, as well as large differences in the quality of lecturers and instructors. The same can be said about various resuscitation and first aid training courses for the public. In many medical facilities, the standard of resuscitation education is still a two-hour CPR training once a year, which is designed as a frontal lecture without practical training, or currently only an online lecture. At the same time, there are several studies that show a significant and, above all, rapid decline in practical skills if they are not regularly practiced. Rarely do these trainings include so-called non-technical skills and teamwork, which are factors that have a direct impact on the outcome of the treatment of many critical conditions and cardiac arrests. From this point of view, the emergency medical services are probably a little further in education, but also selected faculties and large hospitals, although there are also regional differences. I consider it a success that we have recently succeeded in achieving a change in the legislation of the Czech Republic, so that members of hospital resuscitation teams are trained in certified courses with international validity (ALS, EPALS). I believe that the situation will continue to evolve for the better in the field of undergraduate and postgraduate education, as well as lifelong learning courses for health professionals.
Our faculty is proud of its new simulation centre. Will the guidelines be useful for education in this centre?
Undoubtedly yes. Training courses for the European Resuscitation Council are also being developed on the basis of the guidelines, but the procedures will certainly be applied to further education of health professionals and the public. Simulations with varying degrees of credibility are, after all, the future of medical education. In addition, a part of the SIMU team is also made up of excellent lecturers of ERC resuscitation courses, so the interconnection of these activities is and will be sufficiently ensured.