Survival

Lets talk about something nice for a change.

The LAS, not only doing well against nasty infectious diseases in the backs of ambulances, are also doing pretty well in the fight against people dying from cardiac arrest.

The latest figures for the cardiac arrest survival rate are out and we are doing really rather quite well.

In 2001-2002 of the people having a cardiac arrest, only 5% survived to be discharged from hospital.

in 2005-2006 it was 10.9%

Last year the survival chance is up to 15.8% – more than a three-fold increase from 2001-2002.

We must be doing something right. I would suspect that it's partly down to the change in the resuscitation guidelines. We've moved from the old (and very easy) five chest compressions at a time, to a much more knackering, but also much more effective 30 chest compressions at a time. Also our people who answer the 999 calls are moving towards giving people who call ambulances for cardiac arrests better instructions how to start CPR – we are currently in the middle of a research project based around improving these instructions.

The LAS has also been working in putting public access defibrillators in place in addition to training staff, such as rail and tube workers, in their use.

This is funded, not by the government, but by lottery money…

It's good to see us doing something right, just because it is right – even though the government doesn't 'mark us' on it.

There is only one slight downside to this – and it's because of the simplistic way in which the press reports things. The cardiac arrest survival rate is calculated using the Utstein* method. This means (very simplistically) that it is only the people who realistically have a chance of surviving that are counted. Poor old Doris whose heart stopped two days ago doesn't get counted. This is unfortunate in that this reporting still gives some family members a heightened expectation of their relative surviving – in which case it is up to the crew's people-skills to explain what has occurred.


*The cardiac arrest survival figure is calculated using the Utstein method, which takes into account the number of patients discharged alive from hospital who had resuscitation attempted following a cardiac arrest of presumed cardiac aetiology, and who also had their arrest witnessed by a bystander and an initial cardiac rhythm of ventricular fibrillation or ventricular tachycardia (From the LAS release).

16 thoughts on “Survival”

  1. got a question for you regarding CPR, when i was first taught it was 15 compressions & 2 breaths, recently went on a refresher course & it's now 30 compressions & 2 breaths. which do you think is better?

  2. More and more of our general public need to have some form of BLS training. Anybody within reason should be able to perform CPR while waiting for paramedic assistance therefore starting the chain of suvival early. As the St John Ambulance vision states “Everyone who needs it should receive first aid from those around them. No one should suffer for the lack of trained first aiders”.That goes for AED operators as well. Hopfully next year Cardiac Arrest survival rates will continue to rise.

  3. I think the media and mostly TV dramas have a huge part to play in the expectations of the public. Rarely in soaps and hospital dramas does anyone die of a cardiac arrest. From TV you get the feeling you're more likely to survive than die, which clearly isn't true.

  4. DJ,My union, APAP, have been pushing for BLS Training and other First Aid to be part of the National Curriculum in our schools, and I believe Tom has advocated something similar on earlier posts. Then, in time, everyone would have the ability to save lives. Strangely the Government don't seem to be too moved by the idea, perhaps its not a vote winning subject!

  5. 15:2 was the previous standard, after the 5:1 which Tom mentions. It was part of the first international consensus on resuscitation in 2000.Research showed that for most people, oxygenation wasn't the issue (in a sudden cardiac arrest, there is still plenty of oxygen around for a while), but that getting it around was the problem, hence compressions being of more importance. However, it was also discovered that compressions could only give about 30% of the effectiveness of the heart actually beating, and we were only buildling up enough pressure to actually pump a significant amount of blood around after 10-12 compressions. In stopping to provide breaths (which in those days were given over a longer time-frame, and multiple attempts to get them in were encouraged, all of which increased the time compressions weren't being done), this pressure reduced to almost zero and had to be built up again when you restarted compressions. Hence you were getting maybe half a dozen decent compressions which actually pushed blood around per minute, as opposed to the 60-80ish you'd be getting if the heart was actually working.

    Hence the switch to 30 compressions – there was no scientific evidence for that number, it was seen as “more than 15” and “not enough to knacker you out”. I'm yet to see a convincing study comparing survival rates for 30:2 vs 15:2, but like Tom I think the change has played a significant part in the increase in survival.

    Thanks must also go to other things though – public access defibrillation has been a god-send. In high-population/high-throughput areas such as train stations, airports, shopping centres etc., having a defib is rapidly becoming the norm. We're also seeing more and more rural areas set up community first responder schemes.

    Training for members of the public is improving drastically – the numbers of workplace first aiders trained each year is booming, and the HSE's proposal to regulate a shortened course covering basics such as CPR should improve this further. In addition, several large charities such as the British Heart Foundation, Royal Lifesaving Society, St John Ambulance and so on are offering training to schoolchildren, community groups, friends/family of those with heart conditions, and anybody else who is interested.

    The 8 minute response time target now means that ambulance services are pretty much bound to respond to these calls quickly too. On this point Tom and I disagree – there are lots of reasons why survival rates have improved, but one of them is this target. It encourages ambulance services to find more innovative ways to ensure that all calls are responded to quickly – FRUs, CFRs, motorbikes etc. all play an important part in this. We shouldn't kid ourselves that if this target didn't exist, things would be better for cardiac arrest victims – they absolutely would not.

  6. I think some critical messages to get through to lay people are that if they see someone collapse, they have three minutes to act and make a meaningful difference, that any CPR is better than no CPR, and that they don't stop until professional help arrives.People also need to be encouraged not only to do BLS training, but to put it to use. I know from a couple of other people, first aiders and first responders, that I've not been alone in finding out after an event that there were other people present with first aid or even medical qualifications but didn't come forward.

    I find it appalling to have been doing solo CPR when there were people present who could have made it a team effort, further increasing the patient's chances of survival.

    Anyway, for a team effort that did pay off despite the length of time we were working, read this on my blog. I don't know if the patient survived long-term, but our efforts meant that when the paramedic and an ambulance crew arrived they were able to successfully defibrillate him.

  7. I'm looking forward to seeing how well 30:1 has done compared to 15:1 or even 5:1.I'm not too sure that 30:1 isn't enough to tire you – I know I'm bleedin' knackered when I finish – that and my back seizes up after the first cycle…

    I don't think that the eight minute target is bad – just that it is concentrated on to the exclusion of other things. See my 'draft proposal' post, where the ORCON target remains, but other things are more, or just as, important.

  8. Here is the < ahref="http://www.londonambulance.nhs.uk/news/latest/latest.html">press release. There is a complete report, but it's on our intranet. If you want a copy I'd have a chat with the LAS Press office.

  9. That's a great story – although doing three resus must mean that you are some sort of angel of death – do people just drop dead around you?I've noticed that there is a real reluctance to do CPR – once more I think that it is something that should be taught in schools (with a nod to one of the comments further up the page).

  10. What can I say? I'm a casualty magnet. In the past two years alone, I've dealt with seven or eight incidents as a first aider including a couple of RTAs and a major fire.I've done 21 resus attempts in more than 20 years as a first aider, with four of those being successful. I know one of those people survived long term, but I don't know about the other three. (Someone commented that that's a good success rate but what has to be remembered is that in all of those I was at hand when the people arrested so therefore had the best chance of success. Any competent first aider in the same circumstances would have had the same results.)

    Over and above being a casualty magnet, I think two reasons why I've dealt with so many incidents is that I do notice when people are in trouble and I do get stuck in. As you say, a lot of people don't – even when they have the skills.

  11. I read Street Watch, a US paramedic's blog, from time to time, but for some reason I missed one of the best posts I've ever read about why people should learn CPR and put it into practice.

    You go to work, you grind through the tediousness of the day, and then briefly, you have a moment where your hands have helped return life to the dead. And you think, wow, what I have I just done? Its a feeling that verges on holiness.

    That's only a small part of the post, I recommend reading all of it.

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