Withdrawal of treatment after devastating brain injury: post-cardiac arrest pathways lead in best practice.

21 Jun 2018

Every year in England, cardiopulmonary resuscitation (CPR) is attempted on about 30,000 people suffering an out of hospital cardiac arrest (OHCA) [1]. Return of spontaneous circulation (ROSC) is achieved in approximately 25%, and 7–8% of those in whom resuscitation is attempted will leave hospital alive. This figure is below the survival rates achieved in other countries, but, if it could be increased to 10–11%, a further 1000 lives a year could be saved in England [2]. The OHCA steering group aims to achieve this by addressing all aspects of the chain of survival pathway for victims of OHCA, and to this end has published its national framework ‘Resuscitation to Recovery’ in March 2017 [1]. This single consensus document outlines a pathway based on best scientific evidence, national and international guidance, and expert opinion [3, 4]. Key elements of the framework are: to increase the number of patients who receive bystander CPR to more than the current 30–40% of all OHCA, by increasing recognition of cardiac arrest; increasing the number of people trained in resuscitation; increasing the availability and use of public access defibrillators; transfer of patients who have achieved ROSC to recognised centres of care that provide immediate access to echocardiography, CT scanning, a cardiac catheterisation laboratory and advanced circulatory support techniques; management of post-resuscitation care in a general or cardiothoracic intensive care unit (ICU); and addressing the shortage of appropriate facilities for neurological and physical rehabilitation.