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To work with BCIS council to develop recommendations to standardise the care of patients suffering a cardiac arrest (of presumed cardiac cause), driving up standards across the UK with the aim of improving survivor outcomes and quality of life.
Out-of-hospital cardiac arrest (OHCA) remains a significant problem for the NHS. In England in 2019, ambulance services responded to over 80,000 cardiac arrest calls, of which 31,146 subsequently received treatment.1 Fewer than a third (30.7%) of patients in whom resuscitation was attempted by ambulance staff were admitted to hospital with a return of spontaneous circulation (ROSC). Overall survival to discharge was 9.6%.1
In 2017 a national framework for OHCA in England, Resuscitation to Recovery,2 set out recommendations across the patient pathway (‘Chain of Survival’) to improve outcomes. One key recommendation was that all patients with ROSC should be taken to a regionally designated cardiac arrest centre (CAC) for further assessment, triage and clinically appropriate treatment. To date, no allocation or formalised network solution for regionalised CAC exists in the UK.
An analysis of 17,604 patients admitted following OHCA to 239 hospitals in England and Wales identified important variations in outcome; mortality by hospital ranged from 10.7% to 66.3% (median 28.6%, IQR 23.2% to 39.1%), with patient and health service factors explaining only 36.1% of this variation.3 The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) review of hospital care of patients admitted after OHCA identified a number of areas for improvement, including prompt access to cardiologists and interventional cardiology services.4
The BCIS OHCA focus group was formed in February 2020, but COVID-19 in March 2020 meant that the start of activities and meetings were postponed. The group had the inaugural zoom meeting on 20th May, where ambitions and work streams were decided. Workstreams will be delivered by BCIS recommendation, abstract and manuscript publication where appropriate.
THE CURRENT PROPOSED WORKSTREAMS
The focus group has identified 2 main themes in cardiac arrest care which if more standardised and networked would lead to better outcomes for cardiac arrest patients and their families.
OTHER OHCA FOCUS GROUP WORKSTREAMS
FOCUS GROUP ADVISORS
Dr Christian Napp (IC and ICU consultant, Hannover medical school, Germany) – advisor on integration of shock protocols and ECMO / percutaneous MCS.
Dr Guy Glover – Intensive care consultant (Guys and St Thomas)
Dr Max Damian – ICU neurologist and neuro-prognostication expert
Mr Paul Swindell – cardiac arrest survivor and founder of sudden cardiac arrest uk.org
Mr Forrest Wheeler – cardiac arrest survivor
St Bartholomew’s Hospital
Bristol Royal Infirmary
Leeds General Infirmary
King’s College Hospital
Southampton University Hospital