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Out-of-hospital cardiac arrest (OHCA) is a major public health issue that poses significant challenges both in immediate management and long-term follow-up. Survivors of OHCA often experience a combination of complex medical, physical and psychological needs that have a significant impact on quality of life. Guidelines suggest a multi-dimensional follow-up to address both physical and non-physical domains for survivors. However, it is likely that there is substantial unwarranted variation in provision of services throughout the UK. Currently, there is no nationally agreed model for the follow-up of OHCA survivors and there is an urgent need for a set of standards and guidelines in order to ensure equal access for all. Accordingly, the British Cardiovascular Interventional Society established a multi-disciplinary working group to develop a position statement that summarises the most up-to-date evidence and provides guidance on essential and desirable services for a dedicated follow-up pathway for survivors of OHCA., Competing Interests: Disclosure: NC is President of the British Cardiovascular Intervention Society and is on the editorial board of Interventional Cardiology: Reviews, Research, Resources; this did not influence peer review. In the last 36 months; NC has received grants from Haemonetics, HeartFlow, Boston Scientific and Beckmann Coulter Diagnostics and speaker fees from Abbott, Boston Scientific and Edwards. JD has received speaker fees from AstraZeneca. NP has received grants from Heart Research UK. TK has received grants from Abbott Vascular and Treumo, consulting fees from BD and honoraria from AstraZeneca and Abbott Vascular. TQ has received grants from the National Institute for Health Research and the British Cardiovascular Society and is a Non-Executive Director of the NHS Ambulance Trust and Trustee for the British Association for Immediate Care. VO has received speaker fees from Bristol Myers Squibb and Pfizer. All other authors have no conflicts of interest to declare. Funding: This work was partly funded by a King's College Hospital R & D Grant and was supported by the Department of Health through a National Institute for Health Research Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust, UK., (Copyright © 2022, Radcliffe Cardiology.)

Out-of-hospital cardiac arrest (OHCA) affects 80,000 patients per year in the UK; despite improvements in care, survival to discharge remains lower than 10%. NHS England and several societies recommend all resuscitated OHCA patients be directly transferred to a cardiac arrest centre (CAC). However, evidence is limited that all patients benefit from transfer to a CAC, and there are significant organisational, logistic and financial implications associated with such change in policies. Furthermore, there is significant variability in interventional cardiovascular practices for OHCA. Accordingly, the British Cardiovascular Interventional Society established a multidisciplinary group to address variability in practice and provide recommendations for the development of cardiac networks. In this position statement, we recommend: the formal establishment of dedicated CACs; a pathway of conveyance to CACs; and interventional practice to standardise our approach. Further research is needed to understand the role of CACs and which interventions benefit patients with OHCA to support wide-scale changes in networks of care across the UK., Competing Interests: Disclosure: GC has received research grants and consultancy fees from Sedana Medical AB and consultancy fees from BD. NC has received grants from Haemonetics, HeartFlow, Boston Scientific and Beckmann Coulter Diagnostics, as well as speaker fees from Abbott, Boston Scientific and Edwards. NC is president of the British Cardiovascular Intervention Society and is on the editorial board for Interventional Cardiology: Reviews, Research Resources this did not influence peer review. NP has received research grants from Heart Research UK. TK has received research grants from Abbott Vascular and Terumo, consulting fees from BD and speaker fees from Astra Zeneca and Abbott Vascular. TQ is non-executive director of the NHS Ambulance Trust and trustee for the British Association for Immediate Care. The other authors have no conflicts of interest to declare. Funding: This work was funded, in part, by a King's College Hospital R&D Grant and was supported by the Department of Health through a National Institute for Health Research Biomedical Grant, awarded to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust, UK., (Copyright © 2022, Radcliffe Cardiology.)

More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face., Competing Interests: Competing interests: JPdB is member of council for the British Heart Rhythm Society, a co-opted member of council for the Resuscitation Council UK, and a practising interventional cardiac electrophysiologist. EG received Abbott Vascular educational funding. SR is a trustee of Heart Valve Voice and Immediate Past President of the British Cardiovascular Society. NO is Immediate Past President for the Association for Cardiothoracic Anaesthesia and Critical Care. CD is on the Executive Committee for the Resuscitation Council UKALS Working Group, ILCOR. JS is lead of a non-profit cardiac catheter laboratory resuscitation educational programme based in Wythenshawe Hospital, Lead Cardiology Clinician, CLEMS course at Wythenshawe Hospital. AA is Vice President for Clinical Standards, British Cardiovascular Society. TK is an advisory board member of the Zoll Medical COOL AMI EU clinical study, received research funds to support cardiac arrest projects from Zoll, and received speaker fees from BD (www.bd.com). JD is co-founder of Cardiac Advanced Resuscitation Education (www.csu-als.org) which is a group that trains clinicians worldwide for emergencies in catheter laboratories, emergencies after cardiac surgery, and thoracic emergency department care. JD is Deputy Editor of www.ctsnet.org, on the SCTS Thoracic Subcommittee, ISMICS Board of Directors 2017, and is STS Workforce Chairman for guideline for resuscitation after cardiac surgery. All other authors declare no competing interests., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objectives: Cognitive and physical difficulties are common in survivors of out-of-hospital cardiac arrest (OHCA); both survivors and close family members are also at risk of developing mood disorders. In the UK, dedicated follow-up pathways for OHCA survivors and their family are lacking. A cohort of survivors and family members were surveyed regarding their experience of post-discharge care and their recommended improvements., Method: 123 OHCA survivors and 39 family members completed questionnaires during an educational event or later online. Questions addressed both the actual follow-up offered and the perceived requirements for optimal follow-up from the patient and family perspective, including consideration of timing, professionals involved, involvement of family members and areas they felt should be covered., Results: Outpatient follow-up was commonly arranged after OHCA (77%). This was most often conducted by a cardiologist alone (80%) but survivors suggested that other professionals should also be involved (e.g. psychologist/counsellor, 64%). Topics recommended for consideration included cardiac arrest-related issues (heart disease; cause of arrest) mental fatigue/sleep disturbance, cognitive problems, emotional problems and daily activities. Most survivors advocated an early review (<1month; 61%). Most family members reported some psychological difficulties (95%); many of them (95%) advocated a dedicated follow-up appointment for family members of survivors., Conclusions: The majority of OHCA survivors advocated an early follow-up following hospital discharge and a holistic, multidimensional assessment of arrest sequelae. These results suggest that current OHCA follow-up often fails to address patient-centred issues and to provide access to professionals deemed important by survivors and family members., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Patients presenting with ST elevation myocardial infarction (STEMI) are routinely treated with percutaneous coronary intervention to restore blood flow in the occluded artery to reduce infarct size (IS). However, there is evidence to suggest that the restoration of blood flow can cause further damage to the myocardium through reperfusion injury (RI). Recent research in this area has focused on minimizing damage to the myocardium caused by RI. Therapeutic hypothermia (TH) has been shown to be beneficial in animal models of coronary artery occlusion in reducing IS caused by RI if instituted early in an ischemic myocardium. Data in humans are less convincing to date, although exploratory analyses suggest that there is significant clinical benefit in reducing IS if TH can be administered at the earliest recognition of ischemia in anterior myocardial infarction. The Essex Cardiothoracic Centre is the first UK center to have participated in administering TH in conscious patients presenting with STEMI as part of the COOL-AMI case series study. In this article, we outline our experience of efficiently integrating conscious TH into our primary percutaneous intervention program to achieve 18 minutes of cooling duration before reperfusion, with no significant increase in door-to-balloon times, in the setting of the clinical trial.