First ever common standards for cardiac resuscitation

New training and practice guidelines are being issued today for healthcare staff responsible for resuscitating patients who have stopped breathing or whose heart has stopped.

The guidelines do not cover resuscitation itself (separate guidelines exist), but service organisation, training, equipment and facilities needed to ensure the best possible chance to save patients’ lives.

Each year in England, approximately 43,000 patients in hospitals have a cardiac arrest. In addition, there are many more who receive resuscitation in other healthcare settings. Up until now, there have been no nationally agreed guidelines for standards of education, training and facilities and practice has been variable.

Now, a joint statement from the Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council, provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service.

It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post resuscitation care, audit and research. The document should prove useful to those whose role it is to provide a safe and effective resuscitation service within their working environments, and it is hoped that these guidelines will significantly improve the provision of care for patients undergoing attempts at resuscitation in the UK. The main recommendations are:

• Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues.
• Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques.
• Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles.
• Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest.
• Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times.
• Clear guidelines should be available indicating how and when to call for the resuscitation team.
• Cardiopulmonary arrest should be managed according to current national guidelines.
• Resuscitation equipment should be available throughout the institution for clinical use and for training.
• The practice of resuscitation should be audited to maintain and improve standards of care.
• A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly.
• Funding must be provided to support an effective resuscitation service.

Dr David Gabbott, Co-Chairman Working Group and Consultant Anaesthetist, Resuscitation Council, said:

“We have a national obligation to provide an effective resuscitation service in healthcare institutions admitting acutely ill patients. Appropriately trained staff should be continuously available to manage cardiopulmonary arrests when they occur and to help identify those patients at risk of such events. We now finally have a document, written and endorsed by a number of Royal Colleges, societies and interested agencies, that should encourage resuscitation services to thrive, clinical standards to improve and ultimately lead to better patient survival.”

Professor Gary Smith, Co-Chairman Working Group, Consultant in Intensive Care, Royal College of Physicians and Intensive Care Society, said:

“Cardiopulmonary resuscitation is a life-saving procedure, performed daily in many healthcare settings. Patients, and their family and friends, should expect the highest standards in its organisation and delivery. The publication of this document will improve the quality of resuscitation by permitting healthcare organisations to use measurable and nationally agreed benchmarks to audit their practice."

Dr Jerry Nolan, Consultant Anaesthetist, Royal College of Anaesthetists and Co-Chairman, International Liaison Committee on Resuscitation said:

"Those individuals and healthcare institutions with a responsibility for resuscitation services will welcome this comprehensive standards document. Guidance on the training and skills required by members of resuscitation teams is particularly valuable at a time when working patterns of clinical staff are undergoing considerable change. Emphasis on recognition of the critically ill patient and prevention of cardiopulmonary arrest, as well as the delivery of immediate and effective resuscitation, should reduce the number of unexpected deaths in hospitals."

Dr Jasmeet Soar, Consultant in Anaesthetics & Intensive Care, Royal College of Anaesthetists, said:

"There are estimated to be over 20,000 avoidable cardiac arrests in NHS hospitals each year (based on Hodgetts data*). This document provides healthcare institutions with a blue print for an effective resuscitation service. Wide implementation of these standards should prevent many avoidable cardiac arrests and also improve the chance of patient survival if cardiac arrest occurs."