Out of Hospital Cardiac Arrest Survival

Out of Hospital Cardiac Arrest Survival

Heart Attack Clutching Chest

To try and make sense of the vast assortment of (and often contradictory) figures regarding the survival rates of cardiac arrest, the British Heart Foundation, NHS England and the Resuscitation Council (UK) have published a Consensus Paper on Out-of-Hospital Cardiac Arrest in England.

The paper estimates that there are approximately 60,000 cases of out of hospital cardiac arrest (OHCA) in the UK.  During 2013, the Emergency Medical Services (EMS) attempted to resuscitate appropriately 28,000 of these in England.  While mostly aimed above the level of the First Aider, there are a few points that are of interest.

Survival Rates

The paper summaries that off the 28,000 EMS treated OHCA in England, approximately 8.6% survive.  They compare this to North Holland at 21%, Seattle at 20% and Norway at 25%.  It’s clear that we are still a long way behind some countries.  As the paper says:

Improving survival rates from out of hospital cardiac arrest is a major priority for the Resuscitation Council (UK), the British Heart Foundation and NHS England. This was identified by the Department of Health in the Cardiovascular Disease Outcomes Strategy (2013).

Anyone that has completed a first aid course will know that the key to survival during a cardiac arrest is the Chain Of Survival, most notably how quickly and efficiently all 4 links can be completed and / or started.

Chain of Survival
The Chain of Survival in Cardiac Arrest

One of the reasons the paper identifies for such a low survival rate is the rate of initial bystander CPR (First Aid), which in England is approximately 43%.  This means that over half of all cardiac arrest casualties are still not receiving CPR by a first aider or member of the public before the EMS arrive.

Why Are CPR Rates so Low?

The paper suggestions a number of reasons why bystanders may be unwilling to perform CPR.  Top of the list is a failure to recognise that it is a Cardiac Arrest (not noticing that the casualty has stopped breathing normally).  Despite an excellent advertising campaign by the British Heart Foundation on Hands Only CPR, many people still report not knowing what to do.  This is usually coupled with a fear of getting in wrong, doing more damage or gettign sued.

What Can We Do To Improve These Rates?

The simple answer here is we need to get more people trained in First Aid and CPR.  One of the key objectives often quoted is that we need more Public Access Defibrillators (PADs).  However, approximately 80% of OHCAs happen away from Public Places (i.e. at home).  The best chance of survival here is from good quality CPR being initiated quickly.  This will give the EMS a better chance of a successfully resuscitation when they arrive with a defibrillator.  At the moment it is estimated that only approximately 20% of casualties are in a shockable rhythm when the EMS arrive.  This figure is greatly increased when good quality CPR is initiated quickly.

If you want to read the full paper, or see the references for the various figures quoted, you can download a copy at http://www.uploadlibrary.com/aidtraining/OHCAconsensuspaper.pdf