-->PONE-D-25-60471-->-->Mapping and Appraising Evidence Syntheses of Resuscitation Training for Healthcare Professionals: Protocol for a Systematic Review of Reviews-->-->PLOS One

Dear Dr.  Wong,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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ACADEMIC EDITOR: No CCA analysis performed. Please see my comments below. -->-->==============================

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We look forward to receiving your revised manuscript.

Kind regards,

Athanasios G. Pantelis

Academic Editor

PLOS One

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4. One of the noted authors is a group or consortium “LIVESAFERS (Leading Innovations for Emergency Support and Vital Enhancements in Resuscitation Simulation) Study Network” In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address.

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Additional Editor Comments:

Dear Authors,

Thank you for submitting your protocol on mapping and appraising systematic reviews of resuscitation training. Two peer reviewers have assessed the manuscript; their comments are appended. Having reviewed both the manuscript and their assessments, I am returning it with a decision of MAJOR REVISION.

CRITICAL ISSUE: No Plan for Overlap Assessment

This is an umbrella review and the single most consequential methodological challenge unique to this design is the management of overlapping primary studies across included systematic reviews. When the same underlying trials appear in multiple SRs, double-counting inflates the apparent evidence base and distorts synthesis. This issue is well established in the methodological literature (Abdellatif et al., Trop Med Health, 2025; https://doi.org/10.1186/s41182-025-00764-y).

The current protocol contains no plan to address this. Specifically, it lacks:

1. A primary-study overlap matrix identifying which studies appear across which SRs.

2. Calculation of the Corrected Covered Area (CCA) index, the standard metric for quantifying overlap (slight <5%, moderate 6–10%, high 11–15%, very high >15%).

3. Use a specifically developed and appropriately referenced CCA calculation tool (i.e., GROOVE - Pérez-Bracchiglione et al., Res Synth Methods, 2022; doi:10.1002/jrsm.1557).

4. A pre-specified decision rule for managing overlap contingent on the CCA level found.

This omission is particularly consequential given the manuscript's own purpose: a protocol explicitly designed to hold systematic reviews to a high methodological standard must itself meet that standard. The absence of an overlap plan is a methodological irony that peer reviewers, readers, and citing authors will not overlook.

The revised protocol must address all four points above.

ADDITIONAL ISSUES

1. Search scope: Dedicated SR repositories (Cochrane Library, Epistemonikos, JBI Database, DARE) are absent from the search strategy. These are specifically recommended for umbrella reviews (Abdellatif et al., 2025) and their omission risks missing high-quality SRs not indexed in standard bibliographic databases.

2. GRADE: If GRADE is intentionally excluded because this review focuses on methodological mapping rather than intervention synthesis, this rationale must be stated explicitly in the Methods.

3. Data extraction: The extraction form (Table 2) does not capture the results synthesis method of each included SR. Given the review's methodological focus, this is a relevant variable.

Please submit a revised manuscript with a point-by-point response letter. Acceptance is not guaranteed and will depend on the adequacy of revisions.

Yours sincerely,

Athanasios G. Pantelis, MD, MSc, FMBS, FACS

Acsdemic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewer's Responses to Questions

-->Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: No

Reviewer #2: Yes

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-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: Comments

I would like to thank the author for selecting this important and timely topic. The focus of the study is highly relevant and addresses significant gaps in the current literature, which adds value to the field.

Line 30 and introduction-The number of systematic reviews on resuscitation training has grown rapidly, offering valuable 32 evidence to guide healthcare decision-making- Please add global evidence of clear guidance on how much it saves lives.

Line 107- include PROSPERO registration number

What is the scope and distribution of published systematic reviews on resuscitation 115 training interventions? Are you considering adult and child neonatal or all?? Pls state

Methodological quality appraisal-will you plan for do piloting??

Limitations-add more limitations different SR on age categories, different methods difficult to analysis

Reviewer #2: This is an Protocol for review of reviews . Clear and sound design. Looking forward for the actual review - study

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-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #1: Yes:  WDJK Amarasena

Reviewer #2: Yes:  Oliver Kalpak MD PhD

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Mapping and Appraising Evidence Syntheses of Resuscitation Training for Healthcare Professionals: Protocol for a Systematic Review of Reviews

PONE-D-25-60471R1

Dear Dr. Wong,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Athanasios G. Pantelis

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: