Editorial available in 22 out of 121 (18.2%) hospitals and psychological support was not available in 63 out of 123 (51.2%). Before discharge, 133 out of 187 (71.1%) survivors were assessed for physical rehabilitation and 55 out of 187 (29.4%) for neurological rehabilitation. Only 21 out of 105 (20.0%) survivors were offered psychological review. Recommendations Based on these findings, 13 recommendations were agreed, covering five key areas. The six recommendations relevant to the current editorial are shown in Table 1.
Bystander cardiopulmonary resuscitation Ongoing strategies are needed at a population level to ensure that people who sustain an out-of-hospital cardiac arrest are treated rapidly with high quality resuscitation, including defibrillation, through a coordinated network of accessible and identifiable public access devices. This is in line with guidance from the Resuscitation Council UK (Perkins et al, 2021). Advance treatment plans When advance treatment plans are in place, they should be documented using a standard process (such as the ReSPECT form; https://www.resus.org.uk/sites/default/files/202009/ReSPECT%20v3-1-formSPECIMENFINAL_0.pdf) to ensure that patients receive treatments based on what matters to them and what is realistic. Effective communication between all parts of the healthcare system, including primary care, community services, ambulance services and acute hospitals, is then needed to ensure that appropriate decisions are made, irrespective of time or location. Targeted temperature management Elevated temperature is common following an out-of-hospital cardiac arrest and is associated with a worse prognosis, but this can be improved by accurate, active temperature control. The approach in current practice appears to be inconsistent and a more active approach is needed.
Prediction of survival No single factor is accurate enough for clinical decision making at the time of admission to hospital following an out-of-hospital cardiac arrest. Time is needed to ensure an accurate
Table 1. Recommendations from ‘Time Matters’ 1 Implement whole population strategies to increase the rate of cardiopulmonary resuscitation by bystanders and the use of public access defibrillators 2 Put effective systems in place to share existing advance treatment plans (such as the ReSPECT form; https://www.
resus.org.uk/sites/default/files/2020-09/ReSPECT%20v3-1-formSPECIMENFINAL_0.pdf) 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 3 On admission after an out-of-hospital cardiac arrest, prioritise patients for coronary intervention, in line with the
European Resuscitation Council and European Society of Intensive Care Medicine guidelines (Nolan et al, 2021), because a primary cardiac cause for their cardiac arrest is likely 4 Use active targeted temperature management during the first 72 hours in critical care to prevent fever (temperature over
37.5°C) in unconscious patients after an out-of-hospital cardiac arrest 5 Assess neurological prognosis in unconscious patients after an out-of-hospital cardiac arrest, using at least two of the following methods: ■ Clinical assessment ■ Imaging ■ Neurophysiological assessment (including electroencephalogram, to exclude subclinical seizures and improve accuracy) ■ Biomarkers 6 Identify all inpatient survivors of an out-of-hospital cardiac arrest who would benefit from physical, cardiac, neurological and/or psychological rehabilitation before hospital discharge and ensure this is offered to them
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British Journal of Hospital Medicine | January–February 2022 | https://doi.org/10.12968/hmed.2021.0646