They think it’s all over-managing post cardiac arrest syndrome

Since the release of the 2005 Resuscitation Council (UK) guidelines (Nolan J et al, 2006) there has been an emphasis on the active management of the physiological derangement that follows Return of Spontaneous Circulation (ROSC). This has occurred because despite increasing number of patients achieving ROSC, the number of patients leaving hospital neurologically intact has not increased by a similar magnitude (Nolan et al, 2007; 2008) As a result, clinicians are now focusing their attention on what is perceived to be the weak link in the ‘chain of survival’.

In 1966, Friedrich Wilhelm Ahnefeld coined the phrase ‘rescue chain concept’, which was the original German name for the ‘chain of survival’ (Baskett and Baskett, 2007). Since then, clinician have been striving to reduce the number of deaths from sudden cardiac arrest and with the clinical advancements that have been made in the intervening years, it would be logical to conclude that hospital discharge rates would have increased dramatically. However, survival rates to hospital discharge after OHCA are still only 7–10 % (Nolan et al, 2007, 2008). A review conducted in 2008 by The International Liaison Committee On Resuscitation (ILCOR), found considerable variation in patient management outcomes in the post cardiac arrest phase. They also identified that where protocols existed to standardize post resuscitation care across the multidisciplinary team, the institutions involved demonstrated improved outcomes (Nolan et al, 2008). More recently, the Department of Health has introduced a series of clinical performance indicators for ambulance trusts, including ROSC on arrival at hospital and survival to discharge following OHCA (Ambulance Statistics Team, 2011). This makes a review of treatment guidelines for the last link in the chain of survival, post resuscitation care, necessary.