Time matters but getting the basics right is key to survival in out-of-hospital cardiac arrest

A recent report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) highlights some key points relating to the treatment and outcome of patients who suffer out-of-hospital cardiac arrest (OOHCA) in the UK.1 Its aim was ‘to identify opportunities to improve the organisation of services and the clinical care of patients following an OOHCA, to enhance the overall quality of care they receive’. In the 12 months of 2018, the Out-of-Hospital Cardiac Arrest Outcomes Registry at the University of Warwick recorded 30 829 patients who had an OOHCA for whom the emergency services were called and resuscitation was attempted. Adult patients with medical arrest who were transported to the hospital and who had a sustained return of spontaneous circulation (ROSC) were included, with a sample taken from each hospital resulting in the analysis of 699 questionnaires and 416 case note reviews. Overall, there was a 9.7% survival to hospital discharge, consistent with previous UK data, and a recent meta-analysis of global survival rates.2 However, the international picture is one of improving survival in the best systems with some reporting survival rates of up to 28%,3 so in reality, this may mean that the UK is lagging behind, despite laudable initiatives to improve outcomes.4 The report highlights that the key elements of successful resuscitation are the basics: witnessed arrest with early and effective bystander cardiopulmonary resuscitation (CPR) and access to early defibrillation. Many elderly patients come to the end of their lives and do not have a reversible cause for their cardiac arrest. However, the mean age in this report …