Background:

Annually English NHS Ambulance Services treat over 30,000 out-of-hospital cardiac arrest (OHCA) patients. When an OHCA occurs resuscitation must be started quickly. Despite the best efforts of ambulance staff less than 10% survive to hospital discharge. This means that ambulance staff often must make the difficult decision of when to stop resuscitation. They are helped by following guidelines, but they were written over 20 years ago and need updating. The old guidelines no longer correctly guide paramedics when to stop treatment or when to carry on. This means that treatment may be stopped too soon in some patients who might benefit from carrying on. In other patients, the guidelines suggest moving the patient to hospital despite the fact they have no chance of surviving. The knock-on effects of this are journeys with blue lights and sirens which put ambulance staff and other road users at risk of injury from crashes. Patients are separated from their families and taken to a busy hospital. At the hospital, it is difficult for staff to allow the family to spend quiet time with the patient. Hospitals also become overcrowded which can affect other patients. This research will develop new guidelines based on the most up to date information available. It will consider how the new guidelines might work in real life. We will find out the views of ambulance and hospital staff, patients, and relatives. This will help make sure the guidelines are acceptable to everyone.

Policy and Practice Partners:

Prof. Frances Griffiths, University of Warwick

Prof. Anne-Marie Slowther, University of Warwick

Prof Ranjit Lall, University of Warwick

Prof. Aloysius Siriwardena, University of Lincoln

Prof Rachael Fothergill, London Ambulance Service

Mr John Long, PPI

Prof. Aileen Clarke, University of Warwick

Prof. Stavros Petrou, University of Oxford

Co-Funding partners:

NIHR Health Services Delivery Research

Aims and Objectives:

The primary aim of the project is to develop an evidence-based guideline that assists paramedics, when making decisions during OHCA that optimises outcomes for patients and is sensitive to needs of relatives and demands on NHS services.

Methods:

This is a mixed-methods study to establish the clinical criteria to indicate that continuing resuscitation is futile; when the decision to discontinue resuscitation should be made; who should make the decision and where the decision should be made, among adult OHCA patients who do not respond to resuscitation efforts. The study consists of 5 work packages:

1. Describe the content and performance characteristics of existing termination of resuscitation rules in adults who are treated for OHCA.

2. Identify areas of consistency, variation and clinical risk associated with termination of resuscitation practices across the UK ambulance services.

3. Examine current NHS ambulance termination of resuscitation practice and model effects of alternative rules on patient flow and outcomes.

4. Explore the perspectives of patients, relatives, paramedics and emergency medicine staff and consider the ethical aspects of termination of resuscitation rules.

5. Synthesise the information obtained above to develop evidence-based, ethically grounded, consensus guidelines, that optimise outcomes for patients and are sensitive to the needs of relatives and the demands on NHS services.

Main Results:

Not available yet

Conclusions:

Not available yet

Implications for Implementation:

The research will support the implementation of an evidence-based termination or resuscitation guideline for paramedics employed by NHS ambulance services. It will improve healthcare quality for patient experiencing OHCA and their families by engaging clinicians, patients, ambulance services and policy makers to provide better care, by reducing variation in practice and optimising the use of limited health resources.