Time matters: reviewing the care provided to patients admitted to hospital following an out-of-hospital cardiac arrest
The National Confidential Enquiry into Patient Outcome and Death reviewed the organisation of services and the quality of clinical care provided to patients who were admitted to hospital following an out-of-hospital cardiac arrest. The report looked at all four links in the ‘chain of survival’, covering the last link, in-hospital advanced life support and post-resuscitation care, in most detail.
Author details can be found at the end of this article Correspondence to: Neil Smith; email@example.com
How to cite this article: Smith N, Koomson D, McPherson S, Juniper M. Time matters: reviewing the care provided to patients admitted to hospital following an out-of-hospital cardiac arrest. Br J Hosp Med. 2022. https://doi.org/10.12968/ hmed.2021.0646
ntroduction Approximately 60 000 out-of-hospital cardiac arrests occur in the UK every year (Resuscitation Council (UK) et al, 2014) and UK ambulance services attempt resuscitation in an estimated 30 000 people per year (Hawkes et al, 2017). There is considerable variation in both the rate of return of spontaneous circulation at hospital handover (13–27%) and the rate of survival to hospital discharge (2.2–12%) (Perkins and Cooke, 2012). On average, fewer than 1 in 10 people in the UK survive an out-of-hospital cardiac arrest.
The four links in the out-of-hospital cardiac arrest ‘chain of survival’ are: 1. Early recognition of cardiac arrest and call for help 2. Early bystander cardiopulmonary resuscitation 3. Early defibrillation 4. Early advanced life support and standardised post-resuscitation care.
Since 2013, the Out-of-Hospital Cardiac Arrest Outcomes Registry has been collecting comprehensive data on the first three links in the ‘Chain of Survival’ from ambulance services in England (Out of Hospital Cardiac Arrest Outcomes (OHCAO) Registry, 2018). The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) study (Juniper et al, 2020) included data on all aspects of the chain, but focused on the fourth link by addressing the following: ■ Percutaneous coronary intervention for acute coronary syndromes ■ Targeted temperature management ■ The timing and approach to assessment of neurological prognosis ■ Assessment by a heart rhythm specialist ■ The availability of rehabilitation support. The National Confidential Enquiry into Patient Outcome and Death method The NCEPOD undertook a review of the organisation of services and the quality of clinical care provided to patients who were admitted to hospital following an out-of-hospital cardiac arrest. A cohort of patients was identified for study inclusion who were 16 years old or over, had an out-of-hospital cardiac arrest and achieved subsequent sustained return of spontaneous circulation for more than 20 minutes. Patients were excluded if their outof-hospital cardiac arrest was a result of trauma, drowning, asphyxia, drug overdose or poisoning. Up to nine patients per participating hospital were selected.
A retrospective clinical questionnaire was completed by the consultant caring for the patient during the admission and peer review of case notes was undertaken in 416 patients by a multidisciplinary group of healthcare professionals. Organisational data were collected regarding facilities, equipment and policies relevant to the management of patients who had experienced an out-of-hospital cardiac arrest.
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British Journal of Hospital Medicine | January–February 2022 | https://doi.org/10.12968/hmed.2021.0646