Analysis

Not enough is being done to cut risk of death after cardiac arrest, says expert group

A group of cardiac experts and campaigners on the Out of Hospital Cardiac Arrest steering group says that not enough is being done to cut the number of people who die following cardiac arrests

A group of cardiac experts and campaigners on the Out of Hospital Cardiac Arrest steering group says that not enough is being done to cut the number of people who die following cardiac arrests

How much is being done to cut the number of people who die after cardiac arrests in public places? Not enough, says a group of cardiac experts and campaigners on the Out of Hospital Cardiac Arrest (OHCA) steering group.

The group endorsed by 20 organisations including the British Cardiovascular Society, the RCN and the Resuscitation Council has produced a report, Resuscitation to Recovery , which describes 11 ideas as part of a strategy for tackling the issue.

The report says that paramedics attempt

...

A group of cardiac experts and campaigners on the Out of Hospital Cardiac Arrest steering group says that not enough is being done to cut the number of people who die following cardiac arrests

How much is being done to cut the number of people who die after cardiac arrests in public places? Not enough, says a group of cardiac experts and campaigners on the Out of Hospital Cardiac Arrest (OHCA) steering group.


Picture: Science Photo Library

The group – endorsed by 20 organisations including the British Cardiovascular Society, the RCN and the Resuscitation Council – has produced a report, Resuscitation to Recovery, which describes 11 ideas as part of a strategy for tackling the issue.

The report says that paramedics attempt resuscitation in almost 30,000 people a year in England following a cardiac arrest in a public place, but only 7-8% survive. The general public, including schoolchildren, need to know more about how to respond if someone has a cardiac arrest in their presence – including using cardiopulmonary resuscitation (CPR) and publicly accessible defibrillators (PADs), the report’s authors argue.

They quote the Department of Health in suggesting that approximately 1,000 lives a year could be saved if public knowledge of these techniques was better.

30-40%

Of victims of out of hospital cardiac arrest receive bystander CPR

The report states: ‘The chances of survival are time-dependent; the longer the attempted resuscitation is delayed, the worse the outcome. In patients with a shockable heart rhythm, there is approximately a 10% reduction in survival likelihood for every minute’s delay in providing defibrillation. However, the chance of survival can be increased two-to-threefold by the immediate provision of bystander CPR.’

Tom Quinn, a cardiac nurse and professor of nursing at Kingston University London and St George’s, University of London, and a member of the group who developed the framework, agrees and says it is important nurses encourage as many people as possible to learn how to carry out CPR.

Encouragement

He explains: ‘Every nurse is a member of society; a family member and a neighbour – and so he or she can help by raising awareness about CPR, and about the existence and ease of use of public access defibrillators.’ 

Professor Quinn points out that in 2001 the incumbent chief nursing officer for England, Sarah Mullally, set out ten key roles for nurses; one was they should ‘carry out a wide range of resuscitation procedures, including defibrillation’.

The Resuscitation to Recovery report also calls on each urgent and emergency care network in England to establish an effective and consistent pathway of care for OHCA patients, from the point of initial resuscitation to management in designated OHCA treatment centres (cardiac arrest centres).

Professor Quinn says: ‘We already have national and international guidelines about how patients who have had an out-of-hospital cardiac arrest should be treated, but there is evidence of variability in outcomes.

'Nurses need to be part of discussions in their local urgent and emergency care networks to design consistent pathways alongside ambulance services, cardiologists and other specialists. The pathways could be about deciding when a patient would be taken by the ambulance service to an emergency department and when they should go straight to a cardiac catheter laboratory in a designated cardiac arrest centre.’

80%

Of cases of out of hospital cardiac arrest have a cardiac cause

He added: ‘It’s all about organising systems so the patient goes to the right place at the right time, in the same way that pathways for people who have had strokes or myocardial infarctions have been so successful in recent years. We need to do the same thing for patients who have had cardiac arrests.’

RCN professional lead for acute, emergency and critical care Anna Crossley says: ‘We have 44 sustainability and transformation partnerships in England that are designing proposals to improve healthcare for whole regions, not just individual organisations. Not many nurses are involved in devising them and developing them, but nurses can take leadership roles in these to improve the pathways for patients who have had a cardiac arrest.’

Educating schoolchildren

The best way to prevent future deaths linked to cardiac arrest is to make CPR lessons compulsory in schools, argues Matt Griffiths, an emergency care nurse and member of the Resuscitation Council’s executive committee.

In 2005, Denmark introduced compulsory CPR lessons for all children over 11 and in the following six years survival rates from OHCA tripled, the Resuscitation Council says.

Professor Griffiths explains: ‘In the UK we now have defibrillators in public places. That’s a good thing but we need a system of teaching people how to do CPR to start saving lives. We have tried to get CPR on the national curriculum in schools. About 130,000 people signed a petition so we reached the 100,000 target to trigger a parliamentary debate. But the government did not want to take it further.’

Labour MP Teresa Pearce introduced a private members’ bill to Parliament in 2015 aimed at making first aid teaching mandatory in schools, but it did not become law.

Some organisations are doing their bit; the British Heart Foundation has trained about 1.5 million people in CPR since 2004 and wants to reach five million by 2020.

 

Another suggestion in the report is ambulance services needing to have better knowledge of how many PADs are in their regions and where they are located. They can be placed in a variety of locations in towns and cities – in supermarkets and old phone boxes – but ambulance services are not always aware of their presence.

Professor Quinn says: ‘If the ambulance services know where a local PAD is they can send a caller to get it and deploy it while they are waiting for an ambulance to arrive – saving vital minutes – which we know can increase a patient’s chances of survival.’

60,000

Suspected cases of cardiac arrest in the UK annually

The Resuscitation to Recovery report authors believe that the internationally accepted ‘chain of survival’ should be more widely embedded in public consciousness and in clinical pathways and protocols. This involves early recognition that cardiac arrest has occurred, an immediate call to emergency services, prompt initiation of CPR and defibrillation, and high-quality post-resuscitation care.

The authors also say that rehab services post-cardiac arrest need to be better. Ms Crossley believes nurses are ‘ideally placed’ to deliver such services.

Summary of main action points
  • More members of the public should know how to administer cardiopulmonary resuscitation.
  • Clinical networks should work with emergency services and the voluntary sector to promote awareness of, and training in, cardiopulmonary resuscitation and the use of publicly accessible defibrillators.
  • Health professionals need to develop more effective care pathways for cardiac arrests.
  • Outcomes of patients treated in hospital should be captured in national registries.
  • Research to improve understanding of resuscitation is a ‘national priority’.
  • Each network should review the need for neurological rehabilitation services and psychological support for survivors of out of hospital cardiac arrest, as these are ‘suboptimal’.
  • Ambulance services need to improve the way they identify and map the location of defibrillators in public and commercial locations.

 


Christian Duffin is a freelance writer

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to emergencynurse.com
  • Bi-monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs