Out of hospital cardiac arrest: strategy 2021 to 2026

6. Hospital Care

We will ensure specialist in-hospital care to support recovery

Aims:

1. We will support continuous improvement of specialist in-hospital care to improve survival from OHCA.

People who experience a cardiac arrest and have responded to initial treatment often need advanced hospital care for a period of time after the heart has been restarted.

If they are unconscious or vital organs need support, frontline doctors, nurses and other health care professionals working in Intensive Care Units (ICUs) and Coronary Care Units (CCUs) provide specialist life support therapies to provide the best chance of recovery.

Despite receiving life support therapies, high numbers of people continue to die each year in ICU after suffering a cardiac arrest but survival rates with good neurological recovery of up to 60% are possible^{[47] [48]}.

ICU care is a crucial step in recovery from OHCA for people who experience a cardiac arrest and their families. Scotland has a cohesive, joined-up network of highly trained and motivated ICU healthcare professionals, supported by access to high quality data and information systems. We will build upon these unique strengths to support continuous improvement of specialist in-hospital care to support the recovery of people who experience a cardiac arrest. Sharing innovation and excellence through the network of ICU healthcare professionals will help us to achieve this.

Recent research has driven forward treatments for people admitted to ICUs after experiencing a cardiac arrest. In partnership with the Scottish Intensive Care Society and Scottish Intensive Care Society Audit Group, we will develop guidelines, which reflect the most up to date evidence on ICU care for people after cardiac arrest.

Making better use of the high quality information stored in Scotland's unique healthcare databases could enhance our audit systems. We will consider what is important to measure in order to drive effective improvements in care.

Actions:

1. We will develop a national ICU OHCA guideline to include:

• Advice on which patients are likely to benefit from treatment in an Intensive Care Unit.
• How best to coordinate with clinical staff across relevant hospital specialties.
• What is the best way to deliver specialist treatment - such as temperature management (initiation, maintenance, rewarming and normothermia, shivering management, physiologic targets during temperature management).
• Best practice to determine whether ICU treatment is benefitting someone after OHCA (Multi-modal prognostication).
• Improving pathways for rehabilitation after discharge from ICU.
• Advice about organ donation.

2. We will explore the feasibility of embedding components of OHCA care in ICU in the Scottish Intensive Care Society Minimum Standards and Quality Indicators.

3. We will share innovation and best practice about OHCA across Scotland's ICUs to promote rapid translation of new evidence into practice. We will take a holistic approach to this work, encompassing ICU care, bereavement care and post ICU rehabilitation and support.

"I wouldn't be here if it wasn't for the defibrillator at the community centre and someone being able to use it on me. If I could tell you one thing it would be that you can't hurt someone, you can only do good."

Cherill Parry

On Saturday 9th June 2018, Cherill Parry was walking her dog in Gairloch when she started to feel unwell. After visiting her doctor, she arrived home only to collapse on the pavement outside.

"I got out of the car and I don't remember anything for about three weeks after that! I was told that I dropped like a stone on the pavement outside my house, and my neighbour ran across to the community centre to get the defibrillator and used it on me. After that, the doctor and the air ambulance arrived. Apparently I 'died' a couple of times, according to reports."

After three weeks in Raigmore Hospital in Inverness, Cherill was transferred to Edinburgh where she underwent heart surgery to fit a pacemaker. After leaving the hospital she returned to Raigmore for a further two weeks, but is now recovered.

Sadly, Cherill was informed in hospital that her husband Russell had died at home in Gairloch exactly two weeks after her cardiac arrest. At her husband's funeral, a collection was taken for another defibrillator. Little did she know then that this defibrillator would go on to save the life of another person in 2020. Despite enduring such serious illness and personal tragedy, Cherill remains positive about the future and was quick to pay tribute to the role of CPR and defibrillator community groups like Lucky2Bhere. I wouldn't be here if it wasn't for the defibrillator at the community centre and someone being able to use it on me"