Key takeaways from the RCUK session at the 2020 ERC Congress

Resuscitation Council UK (RCUK) was delighted to have a dedicated session at this year’s virtual ERC Congress.  It was a great opportunity to share an update on some of our work with the UK and Europe’s resuscitation community.

We hope you were able to join the session. But, if you missed it, here are our top takeaways: 

Impact of COVID-19
Unsurprisingly, COVID-19 has had a significant impact on our work. We were quick to act at the beginning of the pandemic, to ensure that we agreed evidence-based resuscitation guidance for all settings and disseminated this quickly to the UK’s resuscitation community. 

We pivoted our training at the start of the pandemic to support the NHS, creating bespoke online resuscitation training for those returning to the NHS in Nightingale Hospitals. Looking across the wider NHS workforce, we have also committed to providing our e-Lifesaver online module free to all NHS organisations for 6 months, thus enabling non-clinical staff to gain basic CPR skills. 

The pandemic had a sudden and immediate impact on the availability of resuscitation training across the NHS and we were acutely aware that trainees were joining the NHS frontline early. So, we supported the NHS to help them get training courses back up and running as soon as possible by providing tips to Course Centres on delivering training in a safe environment. It’s been great to see such clear support from the UK’s statutory education bodies on the importance of maintaining training.    

Work is underway to develop the UK’s updated resuscitation guidelines and we expect to publish these in Spring 2021. We’re delighted to have the support of a fantastic group of experts covering neonates, paediatrics, adult and community resuscitation. Watch this space!

The need for more consistent and patient centred discussions around emergency care planning
The pandemic has brought into the spotlight the variations in practice across the UK around emergency care planning. We believe strongly in the importance of personalised, anticipatory care planning and decisions around cardiopulmonary resuscitation. Any such discussions and decisions should be handled sensitively and follow well-established processes. That is why we have worked so hard over recent years to develop the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process and to get it adopted by health and social care organisations in many communities across the UK. The ReSPECT process helps develop a shared understanding between the healthcare professional and the patient of their condition, the outcomes the patient values and those they fear and then how treatments and interventions, such as cardiopulmonary resuscitation (CPR) fit into this. 

Over the last 8 months, RCUK has been deeply concerned by reports of people feeling they or their loved ones were subjected to DNACPR decisions without their consent or with little information to allow them to make an informed decision during the pandemic.  We welcome the Department of Health and Social Care’s commissioning of the Care Quality Commission (CQC) to review the use of DNACPR during the COVID-19 pandemic. We hope that CQC’s review will explore areas of concern as well as best practice around anticipatory care planning and decision making around cardiopulmonary resuscitation. We want to see every regulatory health and social care body provide clear recommendations to ensure that patients and their families experience consistent, high quality, person-centred discussions and decision making around this complex area, wherever they live across the UK.

Last month, we introduced Version 3 of the ReSPECT form, based on feedback from professionals, patients and their families. The new form is even more patient-centred than previous versions and contains more prompts for explicit clinical reasoning. It addresses areas where misunderstandings have been reported and includes more personable and clearer language. We are continuing to work with health and social care organisations to embed the ReSPECT process into practice and are looking forward to feedback from professionals, patients and their families on the updated process so we can continue to improve it.  

Increasing bystander CPR rates to improve survival rates from Out of Hospital Cardiac Arrests
Professor Gavin Perkins presented an update on Out of Hospital Cardiac Arrests and it was great to see that bystander CPR rates and AED use are on the rise. However, we can’t be complacent, as survival rates across the UK are still low.

All four nations of the UK are committed to improving survival rates from Out of Hospital Cardiac Arrests. Efforts to improve bystander CPR rates and AED use are key components to achieving this. 

Increasing awareness and changing the behaviours of the general public around CPR is not something that falls to one organisation and depends on a concerted effort from the NHS, charities and community groups. This collegiate approach has been particularly evident this year with the Restart a Heart initiative, which this year focused its messaging through social media. A wide number of organisations are working to deliver community CPR training, increase defibrillator use, identify and activate nearby first responders, develop resources and tell stories to drive behaviour change.  The Resuscitation Council UK Quality Standards for CPR and AED Training in the Community provides a framework to enhance the community response to cardiac arrest.  

There is a lot more work to do. There are several factors that influence someone’s chances of survival and we need to increase our understanding of these, as well as develop an improved understanding of where the health inequalities exist and put focused effort behind the levers that will address these.

National Cardiac Arrest Audit
The National Cardiac Arrest Audit is an important tool in furthering understanding of resuscitation events that happen in hospital, where an individual receives chest compression(s), and/or defibrillation and is attended by the hospital-based resuscitation team (or equivalent) in response to a 2222 call. It does not include neonates.

We’re grateful to every hospital that takes part and we recognise the difficulties that have been experienced with data collection over the past few months. 
The results for 2019/20 will be interesting and we wait to see the full report at the annual meeting in December. We have been given some advance data which shows that for the 2019/20 report 176 hospitals were taking part. There has been a small drop in the number of cardiac arrests, around 13,200, with a survival to discharge percentage of nearly 24%.

Data collection is important as it:

  • provides hospitals with information on their response to cardiac arrest
  • provides data on the aetiology of cardiac arrests taking place in hospitals
  • poses potential questions for hospital management
  • provokes thought on how a hospital can change processes/procedures to improve data capture and results

Paediatric In Hospital Cardiac Arrests
Dr Sophie Skellett from Great Ormond Street Hospital provided an update on paediatric cardiac arrests taking place in hospitals. 

She shared data from 203 out of 250 hospitals that showed that there were over 1500 paediatric cardiac arrests between 2015-2020 (5-year period). The data showed differences between the return of spontaneous circulation and survival to hospital discharge between children’s hospitals and acute general hospitals. 

Life after surviving a sudden cardiac arrest 
In her presentation, Dr Kirstie Haywood drew upon both quantitative and qualitative outcomes data to inform our understanding with regards to life after surviving a sudden cardiac arrest. She also discussed the implications for future outcome assessment and rehabilitation needs.

Whilst historically little attention has been paid to the experience of survivors following hospital discharge, a growing body of both quantitative and qualitative evidence is raising awareness of the long-term outcomes for this growing and vulnerable group. This includes data from patient-reported outcome measures and explorations of the lived experience of survivors and their families through in-depth interviews.

Accumulating evidence describes far-reaching outcomes, with survival impacting survivors and their family and social networks across a range of cognitive, emotional, physical, spiritual and social aspects of their lives.

Dr Kirstie Haywood argued that the data challenges earlier suggestions that the ‘majority of survivors’ have an acceptable quality of life. Rather, with more targeted and specific assessment, the wide-ranging experiences and often unmet needs of this vulnerable group are evidenced. 

Interestingly, the NHS has committed to provide support services to patients who have recovered from COVID-19.  This is welcome as it’s becoming increasingly evident that patients are experiencing a range of long term physical and psychosocial side after-affects. Improving the support for survivors of sudden cardiac arrest is an area we were already looking to focus more upon, as support for survivors shouldn’t stop once they leave hospital. We hear far too many stories of patients feeling abandoned and unsupported and not getting access to the clinical and psychological services they could need. This is sadly also true for the relatives of both survivors and victims of cardiac arrest. Resuscitation Council UK intends to develop a clinical standard in the next 12 months to push for improvements in this important area.

And finally …..
We’re proud of our work to develop guidelines, influence policy, deliver courses and support cutting-edge research. As fundamentally we want the best outcomes for patients. 

We couldn’t do what we do without the fantastic support from our Trustees, Executive Committee, Sub-committees, Course Centres and Instructor community and the collaboration of charities and community organisations who do so much to drive forward bystander CPR rates. 

Together we can save more lives!