Nurses ‘can help improve outcomes’ for out of hospital cardiac arrests – Nursing Times

The UK's poor record for out of hospital cardiac arrest cases could be improved if patient temperatures were better managed by nurses and other clinicians, according to a new report.

The finding is one of five recommendations in Time Matters, the latest report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

Fewer than one in 10 people in the UK survive an out of hospital cardiac arrest (OHCA) compared to 21% in the US and Holland, and a quarter of patients in Norway.

The report is a detailed investigation into the care, treatment and clinical decision-making relating to OHCA cases across the UK.

The NCEPOD report has five key recommendations:

Bystanders taking prompt action using cardiopulmonary resuscitation (CPR) and public access defibrillators is the key to improving survival rates, according to the report.

It stated: "In the countries where higher survival rates have been achieved, this is associated with higher rates of bystander CPR.

Bystander CPR has been shown to improve the chance of survival by as much as two-fold."

However, once the OHCA patient reaches hospital there were other improvements that could lead to better outcomes, the report added.

One such improvement that involves nurses is around the temperature management of OHCA patients in critical care.

"What, from a nursing point of view, can we do to improve that? Because that's a lot of patients"

Nicki Credland

It is common for fever to occur in the first two days after a cardiac arrest and this can lead to poorer outcomes including brain damage.

Targeted temperature management (TTM) is therefore used in unconscious patients in critical care following an OHCA.

However, the report found that 41.4% of patients included in the review did not receive TTM when they should have.

Significantly, temperature management was rated as "good" in only 18.7% of patients and as "poor or unacceptable" in 57.5% of patients.

A policy on TTM was only available in 77.8% of hospitals included in the review.

The report stated: "Although it is clear that temperature control below 37.5C is important to improve neurological outcome, the approach used in clinical practice frequently does not achieve control of temperature to the desired target."

It concluded: "The current approach in clinical practice appears to be inconsistent and a more active approach is needed."

Nicki Credland, chair of the British Association of Critical Care Nurses, endorsed the NCEPOD report's conclusions.

She said it was the role of critical care nurses to fit the temperature equipment, so lessons should be learned.

Nicki Credland

The fact TTM was only being done in line with a policy in 77.8% of hospitals, might be because not all hospitals had the equipment, such as an intensive care unit, she speculated.

However, this did not explain why the majority of cases were not being done to acceptable standards.

She urged the nursing profession to look into the problem and take action.

Ms Credland said: "The key point is when it says poor or unacceptable in 57.5% of cases. What, from a nursing point of view, can we do to improve that? Because that's a lot of patients. I'd suspect that some of it comes down to training."

In 2018, 11,822 people admitted to hospital in England after OHCA died, while 2,880 survived, according to data from Warwick University included in the report.

Ms Credland emphasised that the most important aspect in saving lives highlighted by the report was resuscitation.

All the later measures were "irrelevant" if this first step CPR by bystanders and the use of public access defibrillators was not carried out and the patient died.

Improving public understanding of CPR was therefore crucial and nurses had a role to play by going into schools and other settings to spread knowledge and awareness, she said.

We see each of the reports five key messages as essential to improving patient survival rates and quality of life"

Sue Hampshire

Meanwhile, the Resuscitation Council UK welcomed the NCEPOD report.

We see each of the reports five key messages as essential to improving patient survival rates and quality of life after discharge from hospital," said Sue Hampshire, director of clinical and service development.

Time Matters followed a review into the quality of care provided to patients aged 16 and over who were admitted to hospital following an OHCA.

The review explored in detail the care provided to patients across UK, Jersey, Guernsey and Isle of Man hospitals who had experienced an OHCA and had a return of spontaneous circulation at handover between the emergency services and hospital.

The mean age of the patients included in the study was 63.5 years, with 65.1% of patients male and 34.9% female.

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Nurses 'can help improve outcomes' for out of hospital cardiac arrests - Nursing Times