• Resuscitation
• methods
• research
• despatch
• comparitive system research
• operational
• effectiveness

It is estimated that approximately 60 000 out-of-hospital cardiac arrests (OHCA) occur in the UK each year.1 2 Resuscitation is attempted by emergency medical services (EMS) in <50% of cases, with non-resuscitation decisions being undertaken according to national guidance.3 The Ambulance Service Association first noted variability in outcomes from cardiac arrest between 2004 and 2006 with return of spontaneous circulation rates ranging from 10% to 25%.1 Recent data from the Scottish and London Ambulance Service confirm similar variability in survival to discharge rates of 1%4 and 8% respectively.5

As part of the focus on improving quality of care, the Department of Health for England introduced survival from cardiac arrest as part of the Ambulance Service National Quality Indicator set in April 2011. Return of spontaneous circulation and survival to hospital discharge rates are reported for all patients who have resuscitation (advanced or basic life support) started/continued by an NHS ambulance service after an out-of-hospital cardiac arrest.6 The first results were published in September 2011 and are summarised in figure 1. Incidence data are not reported, however, as a surrogate measure comparing the number of cardiac arrests with total number of category A 999 calls shows more than threefold differences between services (range 5.2–17.6 per 1000 category A 999 calls). Survival rates similarly show 3–5 fold variability (13.3–26.7% for return of spontaneous circulation upon arrival at the emergency department and 2.2–12% for survival to discharge). This variability …