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Commentary
National initiatives to improve outcomes from out-of-hospital cardiac arrest in England
  1. Gavin D Perkins1,
  2. Andrew S Lockey2,
  3. Mark A de Belder3,
  4. Fionna Moore4,
  5. Peter Weissberg5,
  6. Huon Gray6
  7. on behalf of the Community Resuscitation Group
  1. 1Out of Hospital Cardiac Arrest Outcomes, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
  2. 2Resuscitation Council (UK), Tavistock House North, Tavistock Square, London, UK
  3. 3National Institute for Cardiovascular Outcomes Research (NICOR), UCL Institute of Cardiovascular Science, London, UK
  4. 4National Ambulance Services Medical Directors’ Group, London Ambulance Service NHS Trust, London, UK
  5. 5British Heart Foundation, Greater London House, London, UK
  6. 6National Clinical Director (Cardiac), NHS England, University Hospital Southampton, Southampton, UK
  1. Correspondence to Gavin D Perkins, Out of Hospital Cardiac Arrest Outcomes, Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; g.d.perkins{at}warwick.ac.uk

https://doi.org/10.1136/emermed-2015-204847

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    NHS England report that the ambulance services attempt to resuscitate approximately 28 000 people from out-of-hospital cardiac arrest each year (approximately 1 per 2000 inhabitants per year).1 The rate of initial success (return of spontaneous circulation) was 25%, with less than half of those who are successfully resuscitated initially surviving to go home from hospital (survival to discharge 7%–8%, 2011–2014).1 (see figure 1). The survival rates contrast sharply with those observed in the best-performing emergency medical services systems, which have survival rates of 20%–25%.2–4 In 2013, the government's Cardiovascular Disease Outcomes Strategy for England set the ambitious, but achievable target of increasing survival from out-of-hospital cardiac arrest by 50%, leading to an additional 1000 lives saved each year.

    Figure 1

    Summary of number of resuscitation attempts, return of spontaneous circulation (ROSC) and survival to discharge.

    The chain of survival

    Improving outcomes from cardiac arrest requires improvements in one or more links in the chain of survival.5 The first link is early access. This step prioritises calling for help early in patients at risk of cardiac arrest (eg, those with chest pain) and those with signs of cardiac arrest (unresponsive and not breathing normally). An early response may allow cardiac arrest to be prevented or ensures trained staff arrive early to initiate/continue resuscitation. The second link highlights the critical importance of the bystander providing early cardiopulmonary resuscitation (CPR). Evidence from observational studies suggests that survival from cardiac arrest can be increased from twofold to fourfold with bystander CPR.6–8 Early defibrillation forms the third link as defibrillation within 3–5 min can produce survival rates as high as 50%–70%.9–11 The final link in the chain is early ALS and standardised postresuscitation care. These interventions are initiated by the emergency services, and continued during and after transfer of care to the hospitals.

    Different strategies are needed …

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