Clinical update

Out-of-hospital cardiac arrest: what nurses need to know

A new report shows the value of early interventions and community CPR training

A National Confidential Enquiry into Patient Outcome and Death report shows that timely interventions improve patient survival rates and highlights the need for more community CPR training

Essential facts

According to the Resuscitation Council UK (RCUK), there are around 60,000 out-of-hospital cardiac arrests (OHCA) each year in the UK , with ambulance crews attempting resuscitation in around half of those cases.

Yet on average, fewer than one in ten people in the UK survive an OHCA. This is low compared to many other countries, including Norway, where seven out of ten survive.

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A National Confidential Enquiry into Patient Outcome and Death report shows that timely interventions improve patient survival rates and highlights the need for more community CPR training

Paramedic performs cardiopulmonary resuscitation on a patient in an ambulance
Paramedic performs cardiopulmonary resuscitation on a patient in an ambulance Picture: Alamy

Essential facts

According to the Resuscitation Council UK (RCUK), there are around 60,000 out-of-hospital cardiac arrests (OHCA) each year in the UK, with ambulance crews attempting resuscitation in around half of those cases.

Yet on average, fewer than one in ten people in the UK survive an OHCA. This is low compared to many other countries, including Norway, where seven out of ten survive.

In 2013, the Department of Health estimated that if survival rates in England could be increased to between 10% and 11%, more than 1,000 lives could be saved annually.

The Chain of Survival – a term used to describe the sequence of therapeutic interventions for cardiac arrest – has four key elements. These are:

  1. Early recognition of cardiac arrest and call for help.
  2. Early bystander cardiopulmonary resuscitation (CPR).
  3. Early defibrillation.
  4. Early advanced life support and standardised post-resuscitation care.

What’s new?

In February, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) published Time Matters, its report into OHCA.

This highlights the quality of care received by patients aged 16 or older who were admitted to hospital following an OHCA in 2018, with the aim of identifying variation and remediable factors.

Key findings include that bystander CPR – including using public access defibrillators – improves outcomes, with more than 35% of patients in this study surviving to hospital discharge, compared to 20% who did not receive this intervention.

An elevated temperature is common following an OHCA and is linked with a worse outcome, but this can be improved with active temperature control, says the report. Unfortunately, temperature management was rated as ‘poor or unacceptable’ in more than 57% of those forming the study.

Following an OHCA, time is needed to ensure an accurate prognosis can be made, with no single factor accurate enough for clinical decision-making at the time of admission, says NCEPOD.

As neurological prognosis is particularly difficult to assess, this should be delayed for at least 72 hours after the return of spontaneous circulation, the report recommends.

To ensure a good quality of life for survivors, targeted multidisciplinary support – including physical, neurological, cardiac and emotional – is also highlighted.

The study shows that while more than 71% of survivors were assessed for physical rehabilitation, just 20% were offered a psychological review. ‘In some areas of the UK, there is no provision of these services,’ says the report, which calls for gaps to be closed by local clinical teams and commissioners working together.

How you can help your patients

Clinicians should ensure that when advance treatment plans are in place, they are documented using a standard process, such as ReSPECT, developed by RCUK. This ensures that patients receive treatments based on what matters to them and what is realistic, with a shared understanding between professionals, patients and their families based on meaningful conversations.

Effective communication is needed between all aspects of the healthcare system to ensure appropriate decisions are made, regardless of time or location.

Expert comment

Gabby Wilcox, sister and practice development nurse in the emergency department, Swansea Bay University Health Board

Gabby Wilcox, sister and practice development nurse in the emergency department, Swansea Bay University Health Board

‘A lot of what’s in the Time Matters report supports what we’re already doing.

‘We know that early recognition, early cardiopulmonary resuscitation (CPR) and bystander defibrillation all lead to better outcomes.

‘But this gives us comprehensive support for more CPR training in the community, in which we lag behind many other countries. Our mortality rates clearly illustrate this.

‘I hadn’t realised how much of a difference there was between us and those countries where they emphasise that everyone should have first aid knowledge.

‘The report also highlights a lot of inconsistencies – and that’s what it was designed to pick up.

‘The full report has detailed breakdowns of data, looking at all the different factors and variables, and the influence they have in the context of outcomes. It’s always good to look at how others do things and learn from them.’

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