Out-of-Hospital Cardiac Arrest: A Strategy for Scotland

EXECUTIVE SUMMARY

This strategy, which has been jointly produced by a broad coalition of stakeholders, sets out our commitment to improve outcomes after out-of-hospital cardiac arrest (OHCA) and an ambition that by 2020 Scotland will be an international leader in the management of OHCA.

• We aim to increase survival rates after OHCA by 10% across the country within five years. Reaching this level of performance would mean around 300 more lives being saved every year compared to recent years. Starting an improvement programme now could result in a total of 1,000 additional lives saved by 2020.
• We aim to equip an additional 500,000 people with CPR skills by 2020. Increasing the incidence of bystander CPR is the cornerstone of improving outcomes because prompt bystander CPR can increase the likelihood of survival after OHCA by 2 or 3 times.

Out-of-hospital cardiac arrest (OHCA) remains a significant healthcare challenge in Scotland. Approximately 3,500 patients undergo attempted resuscitation each year after OHCA. Nationally, survival rates from this condition are low compared to the European average, with considerable variation in outcomes between communities. European centres with the best survival rates return almost a quarter of all OHCA victims home alive. In Scotland around 1 in 20 survive to hospital discharge.

The key factors in determining survival from OHCA are early, high quality cardiopulmonary resuscitation (CPR) and counter-shock therapy (defibrillation). All patients who have a survivable cardiac arrest require CPR and the majority also require defibrillation, both of which must be applied in a matter of minutes in order to be successful. CPR and defibrillation can be performed by ambulance first responders, other first responders in the community, or bystanders (if equipment and instruction are made rapidly available). The interplay of these key elements forms the 'Chain of Survival' which a person must successfully pass through in order to go home from hospital neurologically intact. Optimising the Chain of Survival across the whole system of OHCA management means delivering:

• Prompt recognition of OHCA and call for help
• Early, high quality cardiopulmonary resuscitation (CPR) to buy time
• Early defibrillation to restart the heart
• Rapid access to advanced resuscitation skills (e.g. airway management, oxygen therapy, fluid resuscitation and drugs) for those requiring further resuscitation
• Prompt, high quality post resuscitation care
• Transport to the nearest appropriately equipped centre for specialist support. After the return of a pulse (ROSC - return of spontaneous circulation) patients usually require admission to an Intensive Care Unit (ICU) with Cardiology input to preserve heart and brain function
• Co-ordinated rehabilitation services to care for patients and their families

It is essential that the Chain of Survival is underpinned by good data. A comprehensive registry of OHCA cases is at the heart of all the conspicuously successful centres around the world. Scotland's uniquely rich healthcare data offers the possibility of a truly world-leading system, collating information about the whole chain of survival across the whole of the country. This would be a powerful driver for improvement.

The success of this strategy will depend upon the commitment and action of many individuals and organisations. It will require concerted clinical and political leadership and a change in culture around OHCA. A coalition of stakeholders including emergency services, primary and secondary healthcare providers, third sector groups and academics will be required to ensure impact, efficacy and sustainability of a national solution to increased survival from OHCA.

Implementation of this national strategy will be focused on the following aims: