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

Every year, between 36 and 81 people per 100 000—approximately 60 000 people—are estimated to experience an out-of-hospital cardiac arrest (OHCA) in the UK (Noc et al, 2014). Despite a constantly developing healthcare system, the response to and treatment of OHCA have produced consistently poor outcomes in the UK, with an average survival-to-discharge rate of 7–8% (OHCA Steering Group, 2017). While an OHCA may have been previously considered an unequivocally fatal event (Nolan et al, 2012), advances in prehospital and in-hospital experience and capabilities (Noc et al, 2014) mean that, in some instances, long-term patient survival with good neurological function is possible (Nolan et al, 2012; von Vopelius-Feldt et al, 2016).

Despite the introduction of a ‘chain of survival’ concept in recent years, and subsequent developments and improvements made to the first three elements (early recognition and call for help, early cardiopulmonary resuscitation (CPR) and early defibrillation), overall survival-to-discharge rate continues to be approximately 10% on average (Søreide and Busch, 2016); this is further supported by data collected by NHS England (Figure 1) (Keay, 2019). Nevertheless, the chain of survival approach has led to significant changes in local communities, through engagement, awareness and teaching sessions. Furthermore, an increase in community public access defibrillator (cPAD) availability has resulted in significant improvements to the national rate of return of spontaneous circulation (ROSC) outcomes (Nolan et al, 2015a), despite socioeconomic, cultural, administrative and behavioural challenges (Kim et al, 2017).