Resuscitation Council UK (RCUK) welcomes the report, ‘Time Matters’, into the quality of care provided in UK hospitals following an out of hospital cardiac arrest.
We see each of the report’s five key messages as essential to improving patient survival rates and quality of life after discharge from hospital.
The report, published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), followed a review into the quality of care provided to patients aged 16 and over who were admitted to hospital following an out of hospital cardiac arrest.
We believe that all the links in the chain of survival (early recognition and call for help, early CPR, early defibrillation and post resuscitation care) are equally important and the report details how the care given to patients in each link affects outcomes.
The NCEPOD report is a crucial and much-needed investigation into the care, treatment and clinical decision-making that takes place in UK hospitals following an out of hospital cardiac arrest.
We want to see as many people as possible who sustain an out of hospital cardiac arrest receive high-quality care, improving their chance of survival. This would enable more patients and their families to return to the best quality of life after the event.
Currently, fewer than 1 in 10 people in the UK survive an out of hospital cardiac arrest. This important review explored in detail the care provided to patients across the UK, Jersey, Guernsey and Isle of Man hospitals who had experienced an out of hospital cardiac arrest and had a return of spontaneous circulation at handover between the emergency services and hospital.
We welcome the report’s emphasis on the need for ongoing strategies at population level to ensure that people who sustain an out of hospital cardiac arrest are treated rapidly with high-quality resuscitation.
There is firm evidence to show that prompt bystander CPR and access to defibrillation increases a person’s chances of survival. Using data from their Out of Hospital Cardiac Arrest Registry, researchers at Warwick University have shown that there is variation in survival rates across different geographic areas and identified neighbourhood characteristics where sudden cardiac arrest rates are higher and bystander CPR rates and survival rates are lower.
With new and existing charity and ambulance service partners we are committed to building on the Restart a Heart campaign, which aims to increase awareness of cardiac arrests and deliver CPR training to inspire more people to act.
Standardising systems for future care planning
We welcome the recommendation that effective systems should be put in place to share existing advance treatment plans (such as the ReSPECT process) between primary care services, ambulance trusts and hospitals so that people receive treatments based on what matters to them and what is realistic in terms of their care and treatment.
Over recent years we have worked hard to encourage adoption of the ReSPECT process by health and social care organisations. The process helps ensure that people or their families can have meaningful conversations about what matters to them, for there to be shared understanding between professionals and patients/their families and for clinical recommendations to be documented based on this information.
Clinical decision making and prognostication
The NCEPOD report makes important points around clinical decision making and prognostication. These recommendations are in line with the forthcoming UK 2021 resuscitation guidelines that will be published in May, so we encourage clinicians and critical care leads to review their local practices.
It is clear from the report that high-quality cardiac and critical care are a vital part of a patient’s recovery journey. The importance of quality cardiac care is emphasised with access to services such as those provided by the catheter laboratory.
Critical care also impacts on recovery. Areas of note are targeted temperature management (TTM) and neurological assessment and prognostication.
The use of TTM is inconsistent and RCUK would prefer to see the practice delivered appropriately everywhere. We propose that revised 2021 resuscitation guidelines will assist hospitals to deliver on this aspect.
The report advises that assessment of neurological prognostication be delayed until at least 72 hours post return of spontaneous circulation and when the effects of sedation and TTM can be excluded. We again would encourage clinicians to access the revised guidelines when published in May for concise clinical guidelines and access to the scientific evidence behind the guidelines. RCUK will fund an investigation into post cardiac arrest brain injury once the workload and effects of the COVID-19 pandemic has receded. It is expected that this will add to the body of evidence in this area.
Multi-disciplinary support for survivors
The NCEPOD report recognises the importance of multi-disciplinary follow up support for survivors of sudden cardiac arrest, identifying that there is variation in access to follow up.
We agree that it is important that all survivors of cardiac arrest who would benefit from physical, cardiac, neurological, and psychological support are identified before hospital discharge and have support offered to them. The report recognises that assessment does take place to varying degrees, and it is disappointing that the findings show only 20% of survivors were offered psychological review.
We recognise that there is significant variation in the support provided across the UK, and we hear too many stories from survivors who experience physical, neurological, or psycho-social problems for a significant amount of time after a sudden cardiac arrest but have little access to follow up care.
The need for rehabilitation services for COVID-19 survivors was identified by the NHS and we believe the physical and psycho-social needs of survivors of sudden cardiac arrests should be afforded the same degree of importance. RCUK is committed to developing a quality standard for survivors of cardiac arrests, incorporating the latest resuscitation guidelines to be published in May around follow-up care for survivors.
Act on the recommendations
We thank NCEPOD and everyone involved in this important piece of work. It is now vitally important that public health bodies, NHS providers and critical care leads and commissioners review the report’s recommendations and put steps in place to make its recommendations a reality so survival rates, and the quality of life for survivors, continue to improve.