• Improving post-resuscitation care after out-of-hospital cardiac arrest

      Fisher, Ruth (2020-01)
      Abstract published with permission. Introduction: The average rate of survival following an out-of-hospital cardiac arrest (OHCA) in the UK was 7–8% at the start of 2019. An estimated 60 000 OHCAs are attended by UK ambulance services annually and, despite developments in prehospital and post-resuscitation care, there are significant variations in survival between regions and countries. Aims: This study aims to identify the potential for care pathways, evaluate UK practices and review the evidence for direct referral of OHCA patients to dedicated cardiac arrest centres. Methods: Evidence was gathered from 20 articles identified through a systematic search of articles related to OHCA and post-resuscitation care, as well as from NHS England in relation to performance and outcomes. Results: Between April 2018 and January 2019, 30.6% of patients experiencing an OHCA had a recorded ROSC (return of spontaneous circulation), and 10.2% survived. However, the 58.7% compliance with the post-ROSC care bundle by ambulance services suggests variations in the delivery of post-resuscitation care. At present, UK ambulance services stabilise and transfer OHCA patients with ROSC to the nearest emergency department, which may not provide specialist services. Holland and Norway report survival rates of 21% and 25% respectively, and operate a centralised approach to post-resuscitation care through designated cardiac arrest centres, which provide specialist care that helps to improve the likelihood of survival. While no randomised controlled trials have been carried out in relation to cardiac arrest centres, it is recognised that the quality of care in the post-resuscitation phase is important, as this is when the highest proportion of deaths occur. Conclusion: Further research into specific care pathways and centralised care should be carried out, and an OHCA postresuscitation care pathway should be developed to improve the delivery of care and survival.
    • Relationship between hospital characteristics and survival outcomes in out of hospital cardiac arrest (OHCA) patients treated and transported by Yorkshire Ambulance Service (YAS)

      Platt, Anthony (2019-09-24)
      Background There is mounting evidence that post resuscitation care, should include early angiography and primary percutaneous coronary intervention (PPCI) in OHCA where a cardiac cause is suspected. In Yorkshire, the ambulance service can transport patients with a return of spontaneous circulation (ROSC), directly to a regional PPCI unit, if their ECG shows ST elevation myocardial infarction (STEMI) and the PPCI units accept. The aim of this study was to evaluate transport decisions, hospital characteristics and outcome in the form of 30 day survival rates of post-ROSC patients with presumed cardiac aetiology. Methods OHCA patient care records (PCRs) between January and July 2017 were reviewed. Patients were eligible for inclusion if they were: an adult non-traumatic OHCA: achieved ROSC on scene, and were transported to hospital. Descriptive statistics were used to analyse the data. Results 478 patients met the inclusion criteria. 361/478 (75.6%) patients had an ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a PPCI unit. 40/88 (45.5%) of referrals made were accepted by PPCI. Patients taken directly to PPCI were most likely to survive to 30 days (25/39, 53.8%). 34/126 (27.0%) patients survived to 30 days after transport to an emergency department (ED) at a PPCI- capable hospital, and 50/310 (16.1%) survived if taken to ED at a non-PPCI capable hospital. Conclusion Work is required to ensure post-ROSC patients receive a 12 lead ECG, and those with STEMI are referred to PPCI, as survival was greatest in this group. 30 day survival was better for patients taken to ED at a hospital with PPCI facilities, than an ED at a general hospital. Discussion needs to take place between YAS and the relevant hospitals in the region to ensure patients are transported to the appropriate destination., https://emj.bmj.com/content/36/10/e6.1 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.11
    • A service evaluation of transport destination and outcome of patients with post-ROSC STEMI in an English ambulance service

      Platt, Anthony (2020-06-01)
      Background: In the UK, there are approximately 60,000 cases of out-of-hospital cardiac arrest (OHCA) each year. There is mounting evidence that post-resuscitation care should include early angiography and primary percutaneous coronary intervention (pPCI) in cases of OHCA where a cardiac cause is suspected. Yorkshire Ambulance Service (YAS) staff can transport patients with a return of spontaneous circulation (ROSC) directly to a pPCI unit if their post-ROSC ECG shows evidence of ST elevation myocardial infarction (STEMI). This service evaluation aimed to determine the factors that affect the transport destination, hospital characteristics and 30-day survival rates of post-ROSC patients with presumed cardiac aetiology. Methods: All patient care records (PCRs) previously identified for the AIRWAYS-2 trial between January and July 2017 were reviewed. Patients were eligible for inclusion if they were an adult non-traumatic OHCA, achieved ROSC on scene and were treated and transported by (YAS). Descriptive statistics were used to analyse the data. Results: 478 patients met the inclusion criteria. 361/478 (75.6%) patients had a post-ROSC ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a pPCI unit by the attending clinicians. 40/88 (45.5%) of referrals made were accepted by the pPCI units. Patients taken directly to pPCI were most likely to survive to 30 days (25/39, 53.8%), compared to patients taken to an emergency department (ED) at a pPCI-capable hospital (34/126, 27.0%), or an ED at a non-pPCI-capable hospital (50/310, 16.1%). Conclusion: Staff should be encouraged to record a 12-lead ECG on all post-ROSC patients, and make a referral to the regional pPCI-capable centre if there is evidence of a STEMI, or a cardiac cause is likely, since 30-day survival is highest for patients who are taken directly for pPCI. Ambulance services should continue to work with regional pPCI-capable centres to ensure that suitable patients are accepted to maximise potential for survival. Abstract published with permission.