Chain of survival for out of hospital cardiac arrests must be improved, say cardiology experts

In this week’s BMJ, two cardiologists from the Royal Free Hospital in London suggest the evidence base is strong for changing the way people who have had a cardiac arrest outside hospital are treated.

The British Heart Foundation recently stated that the number of people dying from cardiac arrest was “unacceptable” whilst reinforcing the message that all schoolchildren should be taught CPR.

Approximately 60,000 out-of-hospital cardiac arrests (OHCA) occur in the UK each year and current UK survival rates remain extremely poor at 2-12%.

Doctors Malhotra and Rakhit say that the “chain of survival […] makes the difference between life and death” with early defibrillation “crucial”. With every minute of CPR delay, there is a 10% decrease in survival but when combined with effective defibrillation, results in survival rates exceed 50%.

Surveys have revealed that only 1 in 13 people in the UK feel confident enough to carry out emergency first aid. And with studies showing that 12-16 young people die from sudden cardiac arrest every week in the UK, the Royal College of Paediatrics and Child Health support calls for every public building, including schools, leisure centres and football stadia to have an automated external defibrillator (AED).

Malhotra and Rakhit say that we can learn lessons from places such as Norway and Seattle, USA, where “appropriate allocation of resources to this link in the chain of survival has reduced mortality”.

They say that the British Heart Foundation should be commended for their national awareness-raising on the importance of CPR and believe their policy statement, which calls for all UK governments to ensure the inclusion of emergency life support, should be implemented. They say there is “scientific evidence to support early defibrillation” and that AEDs have “the potential to save thousands of lives”.

The authors also note that there are currently 16 automatic external defibrillators in parliament.

They conclude that “we should implement the evidence that will help save thousands of lives”.