In England in 2013 the ambulance services attempted to resuscitate approximately 28,000 cases of Out of Hospital Cardiac Arrest (OHCA). There are many more cases of OHCA where resuscitation is not attempted, often because the victim is beyond resuscitation. This could be because the victim has been dead for several hours, or has suffered severe trauma which is not compatible with life, or because the opportunity to start resuscitation was not taken sooner while the ambulance was on their way.
The overall survival rate in England for those with resuscitation attempts outside of hospital is 8.6%, significantly lower than other developed countries such as North Holland 21%, Seattle 20% and Norway 25%.
Approximately 80% of OHCAs occur at home and 20% in public places.2 When the ambulance service arrives, only about 20% are in a ‘shockable rhythm’ (i.e. treatable by defibrillation and therefore most likely to survive).
The chance of the victim being in a shockable rhythm could be increased if more cardiac arrest victims received immediate and effective CPR from bystanders. In fact, one study from Sweden shows survival rates doubled for those who have bystander CPR. When someone has a cardiac arrest, every minute without CPR and defibrillation, reduces their chances of survival by 7–10 per cent.9,10,11 The current rate of initial bystander CPR in England is reported as being 43% (compared to 73% in Norway).
The low figure in the UK is believed to be due to a number of different reasons including lack of knowledge, fear of causing harm or being sued, or failure to recognise cardiac arrest.
The Chain of Survival is a sequence of steps and it demonstrates that for a person to have the best chance of survival, the following circumstances should occur:
- Their cardiac arrest is either witnessed by a bystander or the victim is discovered immediately after collapsing and calls 999 immediately
- The bystander delivers effective CPR without delay
- A defibrillator is used without delay either by bystanders or the emergency services
- Advanced Life Support is initiated as early as possibleHere at ECG, resuscitation training for the pre-hospital environment is at the heart of what we do. We strive to help you deliver the best possible care and be ready for the unexpected. Call us today to see how we can help with your training needs.
Consensus Paper on Out-of-Hospital Cardiac Arrest in England 22nd September 2015
NICE Eyes on Evidence, March 2016
Written by Sophie McCracken 28th July 2017