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Issue 28 - Summer 2014
Newsletter
Training people, saving lives
•
Changes to full membership
•
Symposium 2014 6 November 2014
and last call for submissions of free papers/posters
•
Symposium 2015 26 November 2015 - Save the date
in your diary
•
RC (UK) statement on the judgement R (David
Tracey) v (1) Cambridge University Hospitals NHS
Foundation Trust (2) Secretary of State for Health
•
European Restart a Heart Day 16 October 2014.
What will you be doing? Read Hilary’s story.
•
Teaching resuscitation in a public hospital in
Northern Afghanistan A project by Nich Woolf
The Resuscitation Council (UK) exists to promote
high-quality, scientific, resuscitation guidelines that are
applicable to everybody, and to contribute to saving life
through education, training, research and collaboration.
•
National Cardiac Arrest Audit update
•
National Cardiac Arrest Audit annual event
•
NCEPOD report ‘On the right trach?’ A review by Carl
Gwinnut
•
National database of AED use A report by Mick
Colquhoun
•
•
Chairman’s welcome
•
Anual General Meeting reports
•
Chairman’s annual report
•
ALS Subcommittee annual report
•
ILS Subcommittee annual report
•
EPLS and PILS Subcommittee annual report
•
NLS Subcommitte annual report
•
Paediatric Subcommittee annual report
•
BLS/AED Subcommittee annual report
•
Research Subcommittee annual report
•
Executive Committee members
•
Honorary members
Resuscitation Council (UK)
5th Floor
Tavistock House North
Tavistock Square
London
WC1H 9HR
Management of cardiac arrest during neurosurgery
in adults A publication by Resuscitation Council (UK),
Neuroanaesthesia Society of Great Britain and Ireland,
and Society of British Neurological Surgeons.
•
Use of POCT Glucometers in Emergency Situations
•
ARNI Manual
Keep in contact with us on social media
Contact us
Tel: 020 7388 4678
Fax: 020 7383 0773
Email: [email protected]
Web: www.resus.org.uk
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Resuscitation Council (UK) Newsletter
Issue 28 - Summer 2014
Chairman’s welcome
The Resuscitation Council (UK) has continued to work in many ways to fulfil its aims
and objectives of achieving high-quality training, practice, and research in resuscitation
throughout the UK. Some of this work and the resulting achievements are described in my
annual report and the annual reports from the Chairs of our subcommittees, all of which
appear in this newsletter.
One major piece of work in recent months followed our decision to intervene in the Tracey
case in the Court of Appeal. We wanted to act in the public interest to try to ensure that the
Court had balanced information about the nature and purpose of CPR and about the range
of clinical settings in which anticipatory decisions about CPR are an important part of good
clinical care. Our statement about the judgement is included in the newsletter. Further details of our intervention
and of the judgement can be found on the website www.resus.org.uk/pages/statMain.htm.
As a result of the Tracey judgement there have been varied reactions by the media, by clinicians and by healthcare
Trusts. There is concern that some of these reactions may compromise good clinical care by delaying or preventing
DNACPR decisions, leaving many people in the ‘default’ position of receiving CPR that they would not have wanted.
Decisions relating to CPR are a highly topical subject and are likely to remain a focus of public and media attention
and to be a concern for many patients and their families. Updated guidance from the BMA, RC (UK) and RCN
‘Decisions relating to cardiopulmonary resuscitation’ (‘The Joint Statement’) is expected in October, as are the
findings of a major research project on this topic at the University of Warwick. As a result we have amended the
programme for our Scientific Symposium on 6 November to include information from the research findings, an
expert legal perspective, information about the new ‘Joint Statement’ and some case-based discussions. The
programme details can be seen at www.resus.org.uk/pages/Symposium2014/symposium2014-prog.htm. This is a
good opportunity for you to ensure that your understanding of the ethical and legal aspects of decisions relating
to CPR and of the latest guidance is up to date. We hope that this will equip you to deliver and help to promote
high-quality clinical practice in making, communicating and recording these important decisions. We look forward
to seeing many of you at the Symposium.
In the meantime we hope that you are enjoying the summer.
David Pitcher
Chairman
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Annual General Meeting – Reports
Chairman’s annual report
At last year’s AGM I reported a busy year for the Council, and this past year has been busier
than ever.
Courses
• Our life-support courses and instructor courses trained 137 956 UK healthcare
professionals in 2013.
• The ARNI and FEEL courses are now fully established as Resuscitation Council (UK)
courses.
• Following review and revision with ALSG of the Generic Instructor Course (GIC) work is
under way to review and update the manual that supports it (the ‘Blue Book’).
Continuing Professional Development
We recognise the commitment and efforts of the large body of instructors who teach on our courses and we wish
to support them in maintaining their skills.
• As part of that support we held a successful ALS Instructor Day in Leeds in November 2013 and in May 2014,
we co-hosted with ALSG a GIC Instructor Day.
• In addition we were delighted to co-host with the British Heart Foundation in London a symposium ‘Recent
Advances Improving Outcome from Cardiac Arrest’. This was held in London on Restart-a-Heart Day in October
2013 and was kindly sponsored by the Laerdal Foundation.
• In April 2014 we supported a conference, hosted by the National Council for Palliative Care, on improving endof-life care for people with heart failure. Earlier this month we provided sessions of resuscitation training at the
British Cardiovascular Society’s Annual Conference.
We are very grateful to all those who contributed to the success of these events.
•
We have an excellent programme for our Scientific Symposium on 6 November 2014 and look forward to
seeing members and instructors in Birmingham for that.
Resuscitation in the community
We have continued to promote measures to improve outcomes from cardiorespiratory arrest in the community.
• I am sure that others will mention the nominations and awards achieved by Lifesaver, the interactive film
developed with Unit 9 to instruct members of the public in dealing with medical emergencies.
• Last October, on Restart a Heart Day, we sent a DVD copy of Lifesaver to all UK secondary schools, together
with a lesson plan.
• In partnership with the British Heart Foundation we have continued to lobby for mandatory training in
emergency life support as part of the school curriculum, and I would like to thank in particular Andy Lockey for
his sustained efforts in leading this work.
• Whilst that ultimate goal has not been achieved, we have made some progress, including a published
recommendation from the Department for Education that all schools purchase an AED and some
encouragement of staff trained in first aid to disseminate ELS skills to other staff and pupils.
• In some areas substantial progress has been made, for example in Leicestershire, where Sue Hampshire and I
were pleased to support the launch of a county-wide initiative to place an AED and deliver ELS training in all
schools.
• Other charities continue to provide funding for AED placement and life-support training in the community. I
have been pleased to support one of them, SADS UK, at their two national awards ceremonies in the past year.
• Our work on community resuscitation has included representation on the Community Resuscitation Group,
chaired by Professor Huon Gray. This group was formed after the publication in February 2013 of the
Cardiovascular Outcomes Strategy, and other members include representatives of the British Heart Foundation
and the Ambulance Services. The aims are to increase delivery of bystander CPR, achieve uniformly prompt
access to an AED in the community and optimise the effectiveness of first-responder schemes. Progress is
being made towards development of a national database for public-access defibrillators, and we will be
represented on the Board that oversees that project.
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Issue 28 - Summer 2014
In addition to that work and also integral to it was the development, led by Mick Colquhoun, of ‘A guide to
Automated External Defibrillators (AEDs)’ which is available on our website www.resus.org.uk/pages/Public.
htm to support anyone considering placement of an AED for use in the community.
The Council is also contributing to the funding of a registry of out-of-hospital cardiac arrests under the
leadership of Professor Gavin Perkins.
Collaborative projects
We have continued to work closely with many other organisations on other projects in pursuit of the Council’s
objectives. These projects have included:
• The publication in November 2013 and May 2014 of Quality Standards for CPR in each of several healthcare
settings, led by the Council but developed in collaboration with six Royal Colleges and several other
professional bodies.
• Continuing work to develop guidance, quality standards and a model patient information leaflet on
Cardiovascular Implanted Electronic Devices in people towards the End of Life, during Cardiopulmonary
Resuscitation and after Death led by the Council (Working Group chair David Pitcher), in collaboration with
the British Cardiovascular Society and National Council for Palliative Care.
• Development of guidance on the Management of Cardiac Arrest during Neurosurgery led by the Council
(lead clinician Carl Gwinnutt), in collaboration with the Neuroanaesthesia Society of Great Britain and Ireland,
and Society of British Neurological Surgeons.
• We have supported and advised the Global Tracheostomy Collaborative (lead clinician Carl Gwinnutt).
• We have provided advice and feedback to the Fire & Rescue Service regarding their development of National
Operational Guidance on Water Rescue and Flooding (lead clinician Charles Deakin).
• We have contributed to the development by the Association of Anaesthetists of Great Britain and Ireland of
guidance on Peri-operative Management of the Morbidly Obese Patient (lead clinician David Gabbott).
• We have applied for membership of the Public Records Standards Body, which aims to define quality
standards for the content of healthcare records, especially with regard to digital records. We hope to be able
to ensure that appropriate standards are defined for any records relating to resuscitation, including decisions
about CPR.
• We have advised NHS England following a National Reporting and Learning System review of ‘access to
cooling to reduce brain damage’.
NICE guidance and quality standards
The Council is a stakeholder in and has contributed to several NICE projects during the past year, including Quality
Standards and Clinical Guidelines on:
• Acute Coronary Syndromes
• Acute Heart Failure
• Acute Medical Emergencies
• Atrial fibrillation
• Transient Loss of Consciousness.
Decisions relating to CPR
• The return of the Tracey case to the Court of Appeal in May 2014 raised numerous expressions of concern that
a judgement derived from the legal elements of a single case could have serious implications for and effects
on the quality of end-of-life care provided to many people. After careful consideration the Council applied
successfully to be an Intervener in the case with a written submission and witness statement. It was hoped
that by so doing it would serve the public interest by providing the Court with a balanced view of the range of
settings and clinical circumstances in which decisions about CPR may be needed, and the potential effects on
clinical care of a judgement that stated or implied that every decision about CPR must be discussed with and
have the agreement of the patient and/or their family. The judgement (handed down on 17 June) together
with the Council’s initial statement about this, the Council’s written submission and witness statement are
available on the website www.resus.org.uk/pages/statMain.htm
• The review with the British Medical Association and Royal College of Nursing of our joint guidance on
Decisions relating to CPR is close to completion, but the author organisations have agreed to defer publication
in case the judgement in the Tracey case warrants any amendment to the wording.
• The Council is supporting research at Warwick University into the recording of decisions about CPR.
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Together with the BMA and RCN we wrote to the Secretary of State for Health to request the adoption of a
standard national documentation of decisions about CPR. As a result a meeting was convened and chaired by
Dr Bee Wee, Clinical Director for End-of-life Care at NHS England, to explore how this might be achieved, but to
date there has been limited further progress. We shall continue to lobby for uniformity of documents used to
record CPR decisions.
Guidelines
• I mentioned last year that preliminary work had begun to review our guidance on safer handling in relation to
resuscitation, and this is progressing.
• Our increasing focus over the next year will be on the development and writing of Guidelines 2015 and on any
resulting changes needed to our various courses, course manuals and teaching materials. A Working Group
will oversee this work, chaired by Jas Soar.
Structure and strategy of the RC (UK)
• The increasing activity of the Council that I have outlined continues to increase the workload of the team
in our headquarters and has placed a heavy burden on those members of our Executive Committee and
subcommittees who have taken leading roles in the various projects.
• In addition we recognise the need to communicate effectively with the public and with the media, and to use
all the available channels of communication, including social and other digital media, to achieve this and to
communicate well with our members and instructors.
• The retirement last year of Sara and Bob Harris after many years of service to the Council and to the wider
resuscitation community was followed by the recruitment of new members to the headquarters team. Paul
White has joined us as Business Systems Manager, Crystal Govender as Content Manager and Geraldine Zake
as Executive Assistant and all are making important new contributions to our work, as is Sue Hampshire who is
now our full-time Courses Manager.
• We have formed a small IT strategy group, chaired by Paul White, to oversee developments in our computer
systems, redevelopment of the website, and all new digital technology developments.
• We shall be exploring further ways of strengthening the headquarters team to ensure that the Council can
respond to demands and remain effective.
• Our current subcommittee structure has served us well for many years but we recognise also that some
changes to this may help us to remain both effective and cost-effective in pursuing the Council’s objectives.
• A small group of Officers and headquarters team members took part very recently in a strategy development
exercise and over the coming months we will be reviewing and exploring options to raise the profile of the
Council and try to ensure that we remain viable and continue to deliver our objectives to maximum effect.
• The multidisciplinary membership of the Council and its Committees and Working Groups is regarded as one
of its important strengths. We consider that the previous separate categories of Associate and Full membership
are no longer relevant and bring to this meeting for your approval a proposal from the Honorary Secretary
that a single membership category be open to all registered healthcare professionals with an interest in
resuscitation.
Finance
• Happily our current financial position is stable and you will hear details from the Honorary Treasurer and
Company Secretary in their reports.
Thanks
• As we recognise increasingly the importance of ‘human factors’ and effective teamwork in delivering successful
resuscitation I cannot emphasise enough the fact that the Council’s work and achievements are made possible
only as a result of a high level of commitment and highly effective teamwork of the headquarters staff and the
members of our Executive Committee, subcommittees and Working Groups.
• In particular I want to thank Sarah Mitchell for her skilful leadership of the headquarters team and for the
immense amount of support that she has given to me and to many others as we have grappled with a good
many projects and challenges.
• Although I have mentioned some people by name in this report that does not in any way dismiss or reduce the
importance of the contribution made by each and every member of the entire team and I want to thank them
for that.
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Issue 28 - Summer 2014
As we move into what I am sure will be another busy year I urge everyone to maintain their energy and
enthusiasm as we try to save more lives by promoting delivery of the highest possible quality of CPR in the UK.
I encourage also any members who can and would like to contribute to the work of our subcommittees or
Executive Committee to make that known and thereby seek nomination or recruitment to those committees.
David Pitcher
Chairman
ALS Subcommittee annual report
On behalf of the ALS Subcommittee I am delighted to report another successful year which
is summarised below.
Number of course centres
235
New course centres
5
Number of ALS instructors
Number of ALS ICs
7,310 (6,813 in 2012)
1,742 (1,640 in 2012)
The breakdown of course types is summarised in figure 1. It can be seen that the majority of courses continue to
be the two-day face-to-face course, although approximately one third of courses are now the e-learning course.
Figure 1: Breakdown of ALS course type
Revisions to the ALS course
I am pleased to announce the revised ALS course has now been implemented. To remind you of the progression
of this revision, we conducted the first national survey of ALS providers, instructors and educators in 2012 which
highlighted the key areas required for change in the ALS course. This led to the development of new material
which was piloted in late 2013. Following feedback from the pilot the new course was launched last month.
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Key changes:
1. Intra-osseous access and end-tidal CO2 training have been included.
2. An updated approach to the initial assessment of the critically ill patient.
3. Revised cardiac arrest simulation (CAS) teach sessions to include sepsis.
4. Increased focus on non-technical skills and introduction of the Team Emergency Assessment Measure (TEAM)
checklist into the second series of CASTeaches (CASTeach 4 + 5).
Under the leadership of Joyce Yeung (supported by Natalie Husslebee) we are now formally evaluating the
effectiveness of the TEAM training tool on non-techinical skills and behaviours. We are also collating feedback
from our Course Directors and plan to formally evaluate the course in six months time based on candidate, faculty
and Course Director feedback.
E-learning – Lead Dr Joyce Yeung and Sultana Begum Ali
The Resuscitation Council (UK) continues to make substantial investment in to the e-learning system under the
careful leadership and oversight of Sultana Begum Ali. In 2013/4 all courses (traditional, e-learning, modular, ALS
re-certification) completed the transition to the learning management system (LMS). In addition, EPLS and NLS
course materials are now hosted on the LMS.
The e-learning team are managing the transition of our e-learning material to a new platform called ‘GoMo
Learning’. This is a multi-device authoring tool which will make all content responsive and provide flexibility to the
RC (UK) by allowing us to update content in-house.
With Guidelines 2015 now only 18 months from publication/implementation, we are actively planning the update
to our e-learning and standard training materials.
FEEL-UK Course – Lead Dr Susanna Price
The Focused Echocardiography in Evaluation in Life support (FEEL-UK) has now been fully integrated under the
umbrella of the Resuscitation Council (UK). The course continues to be co-badged with the British Society of
Echocardiography (BSE) and the BSE logo will appear on FEEL certificates.
The working group has completed reviewing and updating of the course material that is due for distribution from
September 2014 via Dropbox. The working group have consolidated centres in London to ensure appropriate
temporal distribution of courses and maximize faculty development (King’s, Brompton-Harefield, Royal London)
and approved centres in Dublin and Southern Ireland.
The course statistics are summarized below:
Number of FEEL courses
17
Number of candidates
455 (210 EBS and 245 RC (UK))
Generic Instructor Course (GIC) 2013
The identification and training of new instructors remains a crucial part of the Resuscitation Council (UK)
sustainability and growth. We are therefore delighted to note an increase in the number of courses and candidates
in 2013. The figures are summarised below:
Number of GICs
70 (65 in 2012)
Number of candidates
1017 (865 in 2012)
Number of GIC course centres
60 (40 RC(UK) 20 ALSG)
New Course centres
1
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Other progress:
• The new GIC was introduced early this year and is receiving positive evaluations.
• The GIC Instructor Day was held in Manchester on 1 May and was well received by those present.
Thanks
I would like to express my thanks for the hard work and dedication of our team of national ALS instructors. I
recognise that it is becoming increasingly difficult for you to secure time off to teach and yet you continue to
deliver world class training to the future generation of doctors and nurses year on year.
I wish to record my grateful thanks to all members of the Regional Representatives who support our on-going
quality assurance programme and to the ALS Subcommittee.
My thanks go also to the administrative staff at Resuscitation Council (UK), namely Sue Hampshire, Dami Daramola,
Helen Keen, Sultana Begum Ali, Jessica Ayo (GIC) and Rebecca Barnard (GIC and FEEL).
Gavin Perkins
Chair, ALS Course Subcommittee
ILS Subcommittee annual report
Course statics:
Year
Centres
ILS candidates
2002
2003
2004
2005
2006
137
160
189
206
219
17281
29805
37704
44733
50816
ILS
recertification
candidates
127
2136
4260
6895
3889
ILS
courses
Recertification courses
1887
3259
4260
4948
5297
18
381
714
1158
553
2007
2008
2009
233
245
250
56041
55926
61948
6277
11395
14355
6047
6012
6652
894
1545
1921
2010
2011
2012
2013
2014*
256
253
256
262
265
64132
67317
65037
66639
23871
17324
18874
21581
21579
6901
6898
7232
7414
7624
2598
2260
2380
2782
2823
863
*2014 data up to 12th May 2014
ILS instructor (ILSi) course:
No of courses run in 2013
No of ILS instructors trained in 2013
26
179
Total no of ILS instructors trained since 2005 (launch of the ILSi course)
8
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Resuscitation Council (UK) Newsletter
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ILS manuals 3rd edition (Guidelines 2010)
290,500 manuals sold since December 2010.
1.
2.
3.
4.
Survey of ILS centres completed and will help guide future course plans.
ILS will adopt aspects of the updated ALS course.
Updates to the ILS instructor course are being implemented by our Educator Catriona Fleming.
The continuing success of ILS depends on the hard work of a large number of individuals whom I wish to
thank:
• the Resuscitation Officers, instructors and staff at course centres across the UK
• the ILS Subcommittee members
• the team in the RC (UK) office, in particular Karla Wright the ILS Co-ordinator, Sue Hampshire, and Sarah
Mitchell.
Jasmeet Soar
Chair, ILS Course Subcommittee
EPLS Subcommittee annual report
It has been a good year for the EPLS Subcommittee. The new EPLS course was piloted in
several centres and my thanks goes to them for their hard work. The feedback received was
collated and the course refined. We introduced the new course at an EPLS instructor Day last
June and then launched it nationally in January this year. The feedback from the first tranche
of new courses has been extremely positive.
Candidate numbers for EPLS remain relatively steady at approximately 2,000 per year and
the PILS course continues to grow with over 16,000 candidates last year. The subcommittee
is working hard to promote the new EPLS course with its inclusion of common paediatric
emergencies and raising its profile through liaison with the Royal College of Paediatrics and Child Health and the
other Royal Colleges.
Now work is commencing to update the course material and manual alongside the new resuscitation guidelines
which will be launched in October 2015. The subcommittee is also looking to the future and introducing
e-learning and developing a one-day course alongside the two day course.
My thanks to the subcommittee members for their hard work and to Karen Cooper and Sue Hampshire.
Sophie Skellett
Chair, EPLS Subcommittee
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NLS Subcommittee annual report
NLS continues to be successful although whilst the numbers of courses seem to increase, the
overall numbers of candidates may be starting to plateau at just over 5000 per year. There
has been an increase in local NLS courses for 12 candidates. We received feedback in relation
to the MCQs which have now been resolved and we are trialling different ways of assessing/
recertifying course centres. Plans for the next manual in 2015 are underway.
This year the NLS was added to the Learning Management System (LMS), which offers
a much better approach to course centre administration despite some early teething
problems with candidates unable to access the internet or failing to answer the pre-course
MCQs. The NLS Subcommittee has decided that all candidates must complete both MCQs to successfully complete
the course.
We have just completed a short documentary on newborn resuscitation, filmed in collaboration with NHcTV and
this will be available on the LMS to all NLS candidates before they attend the course. It will also be made available
on the Council’s website www.resus.org.uk/pages/nlsinfo.htm.
The appointment of a new midwifery representative to the subcommittee is underway. Sue Hampshire has joined
the subcommittee as courses manager and brings organisational expertise and continuity. Mark Sedge stands in
as the new NLS co-ordinator whilst Rowan Davies takes maternity leave. The whole subcommittee wishes Rowan
all the best for her and the future of her family.
The continued success of NLS in the UK is due to the dedication of directors, co-ordinators, instructors and the
support of the subcommittee and staff at RC (UK) all of whom continue to warrant my thanks. It should be noted
that many instructors continue to teach in their own time.
ARNI
The parents group BLiSS have generously supported the Advanced Resuscitation of the Newborn Infant (ARNI)
course which was successfully launched in May in Leicester following a proof of concept course and two 2 pilot
courses. The ARNI manual was available for the launch and has been published by the RC (UK). Instructors who are
interested in buying a copy at a subsidised rate of £25 should contact [email protected]
The ARNI course has received very good feedback and there is a great deal of interest in the UK as well as in
Europe. There may be an issue in nurses securing funding in the future for the courses but this is unlikely in the
short term. The roll out is likely to be controlled and slow initially as the courses depend on a small number of
instructors. This number is increasing but ensuring quality as the course rolls out is paramount.
Jonathan Wyllie
Chair, NLS Subcommittee
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Paediatric Subcommittee annual report
Membership:
Name
Bob Bingham (Chair)
Serena Cottrell
Peter-Marc Fortune
Sophie Skellett
Fiona Jewkes
Ian Maconochie
Jonathan Wylie
Representing
Paediatric anaesthesia
Paediatric intensive care
Paediatric intensive care
Paediatric intensive care
Pre-hospital care
Paediatric emergency medicine
Neonatal resuscitation
The main duty of the Paediatric Subcommittee is to ensure that the Council fully considers the needs of children
in the conduct of its business. The subcommittee offers advice and prepares statements and answers questions on
paediatric matters addressed to the Council.
You will note from the membership listed above that we have no RO member on the subcommittee and we will be
asking for nominations for this position in the near future.
The last year has been quiet (as in ‘before the storm’) and the main duties of subcommittee members has been in
answering the paediatric related questions that regularly come into the Council.
As mentioned last year, Ian Maconochie has taken over from me as lead for the NCAA meetings to provide
paediatric input into the audit. In the last year we have been fortunate to receive a donation of funding for
research into paediatric resuscitation from the family of Liz Greenwood, who sadly died last year. This is being
channelled into the interrogation of the NCAA dataset to review prognostic determinants of CPR in children. There
is also potential to use such data for making international comparisons, which is one of the most promising ways
of generating robust data to inform resuscitation guidelines.
The NICE review of paediatric fluid administration is now well underway but has not yet reported and we eagerly
anticipate its conclusions. The ILCOR process is also underway and with Ian Maconochie as Co-Chair, the Paediatric
Subcommittee is well informed of developments.
Bob Bingham
Chair, Paediatric Subcommittee
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BLS/AED Subcommittee annual report
The last year has been an interesting and productive one for the subcommittee.
1. The major achievement has been the publication of a detailed guide to people or organisations thinking of using an AED in a Public Access Defibrillation role www.resus.org.uk/
pages/Public.htm. This is a detailed document that addresses all the important issues behind
the use of AEDs and implementing a PAD scheme. It was developed in partnership with the
British Heart Foundation (BHF) who have co-badged the document and also placed it on
their own website. It has also been endorsed by the National Ambulance Service Medical
Directors Group. We consulted widely during the preparation of this, taking detailed advice
from the HSE and from Health and Safety practitioners. I would like to thank Andy McGrory at the HSE and David
Osborn of Trident HS&E for their advice.
The preparation of this document also provided a chance to revisit some of our previous advice and statements,
including those relating to the training requirements to use AEDs and the placement of AEDs in public places in
locked cabinets.
The HSE are the only Government body that has any remit concerning first aid, and one consequence of our discussions with them has been the formation of a committee to advise the HSE on clinical matters, this has representation from several Royal Colleges, first aid organisations and training bodies. Two members of the BLS/AED
Subcommittee now sit on this group, myself (representing the RC (UK)) and Chris Smith (representing the College
of Emergency Medicine). This promises to be a valuable and productive forum in the future.
2. We have become aware of wildly different figures published for the incidence of sudden cardiac arrest in the UK
by several different organisations and charities and have decided to try and provide the most accurate figure possible to enable consistent information to be given to the public. This has not been an easy task; the BHF funded
Heartstats unit do not have data on this, and no body or department collects such epidemiological data. We are
working (with the BHF and Public Health England) to try to provide the best evidence based estimates. A literature
search is well under way and we hope to publish figures in the coming months.
3. The AED event forms that are returned following an attempted resuscitation with a public access AED have been
entered onto the database, and entry is complete up to the end of 2010. Starting in 1999, there are now 3500 reports and a summary of the main findings is now available on the RC (UK) website. It was decided that the collection of the forms would now cease and the project in this form would come to an end. The audit of such events will
now be carried out at Warwick University by the group conducting the audit of ambulance resuscitation attempts,
and this will start in the near future. During the year both Bob and Sara Harris retired and I would like to record the
gratitude of the subcommittee to them for their help administering this project and for the design and maintenance of the database.
4. A sign that aims to encourage the use of AEDs in an emergency is being designed. The intention is that it will sit
alongside the standard sign indicating the location of an AED.
5. Members of the subcommittee have also contributed to the NHS England cardiovascular outcomes strategy. This
is particularly relevant, as one principal aim is to increase training in BLS and the use of AEDs. We have also advised
members of parliament on the use of AEDs, particularly in their potential role at schools and contributed to the
work of the BHF in the field.
6. Work has commenced on Guidelines 2015 which will almost certainly be the last set produced by Dr Handley
and Dr Colquhoun. Thought is being given to succession planning and the strategic role of the subcommittee at
a time when basic life support and AED use, particularly outside hospital, is becoming an increasingly important
subject.
Mick Colquhoun
Chair, BLS/AED Subcommittee
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Research and Development Subcommittee annual report
The Resuscitation Council (UK) supports research related to cardiopulmonary resuscitation
and the Research and Development Subcommittee considers all applications for research
funding in this area. An annual budget of £150,000 is available for grants and we maintain
our partnership status with the National Institute for Health Research (NIHR).
During 2013 – 2014 the subcommittee dealt with its business by email and telephone
conference and considered 14 applications during the financial year. A total of £144,829 was
awarded to the following five successful applications:
• Introduction of paramedic led Echo in Life Support (ELS) into the pre-hospital
environment.
• Effect of non-technical skills teaching on performance - an evaluation of new ALS course.
• A prospective study of the role of cerebral oximetry in predicting survival and neurological outcomes
following in-hospital cardiac arrest.
• Ensuring patient safety during hands-on defibrillation.
• Rescuer safety during implantable cardioverter defibrillator discharge.
Out-of-hospital cardiac arrest outcomes
The third instalment of a three-year grant (Out of hospital cardiac arrest outcomes - OHCAO) was paid to Professor
Perkins in March 2014. As of June 2014, there are over 15,000 cases imported into the OHCAO database. Following
receipt of relevant governance approvals, data from the OHCAO project will be used for the European Registry of
Cardiac Arrest (EuReCa) one project in October 2014.
Membership of the subcommittee
I would like to thank Tony Handley and Mick Colquhoun for many years of very valuable work on the Research and
Development Subcommittee. Fair and transparent reviewing of applications takes considerable time and effort
and Mick and Tony’s contributions to this work have been outstanding. In their place, I would like to welcome Jas
Soar and Ken Spearpoint to the subcommittee. I also welcome Geraldine Zake who has taken over from Sara Harris
as the subcommittee administrator.
Review and update of research application procedures
We have developed a more streamlined approach to reviewing applications, which involves a single annual
deadline for applications. We have received 10 applications for this year which are being considered. The final
funding decisions will be made in November.
NCAA (National Cardiac Arrest Audit)
The Resuscitation Council (UK) continues to collaborate with ICNARC on this project and significant progress has
been made in 2013/14. There are now more 180 hospitals participating in NCAA. Risk-adjusted reports are now
part of the routine reports sent to participating hospitals. The first two NCAA papers (overview of first two years
and a description of the NCAA risk model) will appear in the August issue of Resuscitation.
National database of AED use
The Resuscitation Council (UK) has been collecting AED use data since 1999 and published initial results in
Resuscitation in 2008. The RC (UK) intends to publish a further report covering the latest analysis of almost 3500
reports. The RC (UK) has established a national out-of-hospital database with the British Heart Foundation and
Association of Ambulance Medical Directors in partnership with the University of Warwick. As a result of this, the
Resuscitation Council (UK) no longer supplies or collects the AED event form that has been in use.
Thanks
I would like to thank Geraldine Zake for all the hard work she has put into the Research and Development
Subcommittee over the last year. Thank you also to all of the subcommittee members who have volunteered their
time in reading and providing feedback and recommendations on all grant applications submitted.
Jerry Nolan
Chair, Research and Development Subcommittee
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Resuscitation Council (UK) Newsletter
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Executive members
No elections were required this year due to the changes made to the constitution in 2013 to increase the term of
tenure from two years to three years. The list of Executive members can be found on the website www.resus.org.
uk/pages/execcomm.htm
Nominations for Honorary members
All full members were contacted in January and invited to send nominations for Honorary membership. Jas Soar
and Ian Bullock were nominated and their nominations were approved by the Executive as highly deserving for
their invaluable contribution to the Resuscitation Council (UK). The list of Honorary members can be found on the
website www.resus.org.uk/pages/honmembr.htm
Changes to full membership
Full membership is now open to all registered healthcare providers on an equal basis with the same criteria
applicable to all. The Executive Committee hopes this move will properly reflect the multidisciplinary approach of
the Resuscitation Council (UK).
Full members are able to vote at the Annual General Meeting, and can also be nominated to become members
of the Executive Committee. We are currently performing a review of the benefits available to full and associate
members.
If you are a registered healthcare provider as well as an existing associate member you may like to take this
opportunity to convert your associate membership status to full membership at no extra cost for the remainder of
your membership year.
If you are a registered healthcare provider and would like to apply to become a full member please submit the
application form. Your application will be reviewed by the Honorary Secretary before ratification by the Executive
Committee at their next meeting. The Executive Committee meet about three times a year and your application
will not be processed until it has been ratified.
Symposium 2014
The Scientific Symposium is being held on Thursday 6 November 2014 at the National
Motorcycle Museum, Solihull.
Following the recent judgement in the Tracey case, decisions relating to CPR have received a good deal of press
coverage and are increasingly challanging. The programme includes research findings into a review of current
DNACPR practice, an expert legal perspective of the law at the end of life, information about the new ‘Joint
Statement’ and some case-based discussions focusing on difficult decisions in resuscitation.
The day will start at the earlier time of 09.00 and the full programme is available at www.resus.org.uk/pages/
Symposium2014/symposium2014-prog.htm. Please register soon to avoid disappointment.
LAST CALL for submission of free paper/posters
Presentations can be presented either as an oral presentation or as a poster. The
Research and Development Subcommittee will decide which presentations will be
oral and which will be posters (unless you express your wish not to present orally).
If you would like the opportunity to present at the Symposium please submit your
application no later than Monday 1 September 2014. Details and application form can
be downloaded from the website www.resus.org.uk/pages/Events.htm. Please return
your application to [email protected].
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Symposium 2015 – save the date
With the publication of Guidelines 2015, next year’s Scientific Symposium will take place on Thursday 26
November 2015 at the National Motorcycle Museum, Solihull – save the date!
RC (UK) statement on the judgement R (David Tracey) v (1) Cambridge
University Hospitals NHS Foundation Trust (2) Secretary of State for Health
The statement on the judgement together with the RC (UK) witness statement, written
submission and the final judgement are available at www.resus.org.uk/pages/statMain.htm.
European Restart a Heart Day – 16 October 2014
Last year saw the first European Restart a Heart awareness day on 16 October. This initiative
is aimed at increasing survival from out-of-hospital cardiac arrest and to promote this day
the Council sent all UK secondary and independent schools a DVD copy of Lifesaver.
The theme for this year’s European Restart a Heart day is ‘Loved Ones Save Lives’. Most
cardiac arrests occur in the home witnessed by loved ones (including children) who could
provide life support. Hilary Sanders shares her moving story of resuscitating her husband
and how she will be training others in Emergency Life Support skills on 16 Octover. We
would like to encourage all our members and instructors to introduce local initiatives to
help promote the theme of the day. Posters and flyers can be downloaded www.resus.
org.uk/pages/Events.htm#Restart and we will help promote these initiatives and provide
information and pictures on the ERC website.
Our Story – by Hilary Sanders
Norm and I were childhood sweethearts. Born and raised in Devon we lived on neighbouring farms. As often
happens in people’s lives we parted and married other people, however after over 20 years we found each other
again and reignited our love and relationship.
We have been together for over 12 years now but on the night of 9 June 2013 our lives threatened to be torn apart,
this time forever.
We had returned from a week’s holiday in Snowdonia with Norman’s mum, sister and brother-in-law; the weather
had been glorious and we had done quite a bit of walking and climbed Snowdon. The only thing that Norm
complained of when we were near the summit of Snowdon was that he was finding it hard to ‘get his air in’ but this
passed.
When we came home that Saturday afternoon he said he felt tired and was aching. I felt a little suspicious as he
was belching but he had eaten some very out-of-date fish from the fridge so I wondered if this was the cause. As
a heart failure nurse specialist I was concerned that this might be cardiac in origin as he had some family history
but I was also concerned that I might be overreacting. He convinced me that he was fine, did not want to go to
Accident and Emergency and said he would ring his GP on Monday. I gave him some Anadin which he said had
helped and he took some more before retiring to bed. I told him to wake me if he felt unwell.
At 01:30 on Sunday I was woken by the bedclothes being pulled off me. I called to Norm to stop it but there was no
reply. I quickly hit the light switch above the bed and Norm appeared to be fitting, holding his breath, shaking and
unresponsive. He tried to stand by the bed before falling backwards and ending sat up against the wall where all
his breath seemed to expel from him like popping a balloon.
I have never felt so terrified - I was alone in the house in a village, down an unlit track. I went into ‘nurse mode’.
Fortunately we have a phone upstairs and I called 999 informing the person on the phone that my partner had
collapsed. I put her onto the loud speaker and threw the phone on the floor, grabbed Norm’s ankles and pulled
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him flat. I established he was not breathing and as my brain caught up with me I realised that he must be in cardiac
arrest from a myocardial infarction. I relayed this to the lady at the emergency call centre, asked her to send an
ambulance and told her that I was starting CPR.
I attempted one mouth to mouth breath but realised immediately that I was too panic stricken to do this
effectively and did not know how I was going to move from head to chest to do compressions. I knew that it would
be better for me to give really good chest compressions so I focused on this. I asked the lady from the call centre
to just talk to me rather than ask too many questions as I was afraid I would not be able to sustain this for long
enough. Seconds felt like minutes and minutes felt like hours. I remember thinking that the chances of his survival
given the time and location were very slim. I remember thinking he would die. I remember thinking I did not
want to arrange a funeral. I remember thinking that he had two Land Rovers in partial state of rebuild and a pile
of paperwork to be dealt with. I remember shouting and swearing at him to “come back to me” and I remember
thinking that doing only chest compressions was really quite simple as long as I could keep going. I was afraid that
no-one would come and I would have to stop due to exhaustion.
At one point I thought he was breathing and so I positioned him in the recovery position, ran downstairs to the
back door to unlock it so that the ambulance crew could gain entry. I grabbed my mobile and phoned a friend
in the village to ask her to direct the ambulance as I was afraid they might not find the house. I then ran back
upstairs and restarted chest compressions as he was not breathing. After 20 minutes the paramedics arrived. They
established that he was in VF so delivered three shocks to get him into sinus rhythm. I was amazed and in shock
but it was one step nearer to possible survival.
At the Royal Devon and Exeter hospital he had emergency PCI performed to open a blocked coronary artery and
six weeks later he underwent a double bypass in Derriford hospital.
On 7 March 2014 we were married. Following six months off work Norm now works full time assisting in running
a grain store in Devon. Currently he is working 14 hour days, six days a week due to it being harvest time. He feels
better now than before the heart attack.
So many people that we know locally have been amazed by our story and have said that they would not know
what to do in a similar situation. We have started a HeartStart project backed by the BHF and have formed a group
of people to train others in emergency life support (ELS). On 16 October - Restart a Heart Day - we will be training
the first members of the public in ELS. We want to give people the skills and confidence to give ELS, to restart a
heart and save a life.
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Teaching resuscitation in a public hospital in Northern Afghanistan – A project by Nich
Woolf
Having visited Afghanistan on several occasions and carried out a few tasks for a charity, Sandy Gall’s Afghanistan
Appeal (SGAA), I was interested to see a report from an anaesthetist highlighting the surgical risks of working in
the public hospital in Mazar e Sharif. The anaesthetist had travelled with an orthopaedic surgeon and they both
complained that the hospital staff lacked basic equipment and skills to ensure the safety of patients. I promised
SGAA that I would try to rectify this situation.
I emailed people who had worked in the hospital and some staff working for a German agency building a new
hospital on the site to get an idea of what was needed. Slowly the information built up:
• Although a new hospital was being built the contract to equip the new building was delayed and there were
serious shortages of equipment and consumables. For instance single use ET tubes were being boiled 30 or 40
times for use in surgery.
• Staff skill levels were low. Medical training in Afghanistan is not well regulated. There is very little practical
training; there are no standards and no clinical governance. Doctors work as individuals and there is little or no
team work.
A plan was formulated and turned into a project for submission to Festival Medical Services (FMS) a charity
raising money for medical projects by volunteer work at music festivals. FMS agreed to fund the project and have
continued to do so for all three trips.
Although the aim was to improve the safety of surgery the root cause of the problem was identified as the lack of
teamwork amongst the doctors coupled with a lack of structure to their training and development. Several doctors
had visited Western countries but had been only allowed to watch procedures way above the capabilities of the
hospital. They had not had hands on training in the basics of assessing and treating sick patients. Balanced against
this they had huge experience of the extremes of hypovolaemia and sepsis without the benefit of standards to
work to.
The first trip, October 2011, took 150kgs of equipment and some training in the use of equipment as well as
resuscitation training. It was also an opportunity to do a proper assessment of the training needs.
The direct result of the first trip was to purchase resuscitation manikins and to make the second trip, April 2013, to
train trainers in Basic Life Support (BLS). The equipment contract had still not materialised and morale was at a low
point. BLS was used as a way in to standard setting and getting the point over that the staff needed to organise
themselves.
The third trip aimed to train the original trainers in Advanced Life Support (ALS) but it was discovered that the
senior doctors resented junior doctors having more skills than themselves. It was therefore necessary to run
training sessions for the senior doctors. Although this was a setback it demonstrated that trip two had worked and
that there was acceptance that resuscitation was an essential skill.
The equipment contract, from Japan, had at last arrived in October 2013. This coupled with the training of the
senior doctors helped to persuade the Ministry of Public Health finally to start the training programme for ICU staff
in a hospital in Iran. Thus the hospital staff will be able to resuscitate patients and have an ICU facility to send them
to.
Issues arising
Security is always a concern in Afghanistan and the number of times one is searched coupled with the amount
of weapons on display serves as a reminder to be wary at all times. Since my first visit when anti-personnel mines
were a real concern the tension has visibly lessened. However death threats to Afghan friends have increased
whilst the kidnapping of Westerners has decreased. This drives home the realisation that whilst I can go home to
relative safety my students are stuck in a world of terror and uncertainty.
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Training in a different culture can raise a number of issues; some foreseen and some unexpected. The first problem
to come to light was the absence of any literature in Dari, the language of ancient Persia. After a few false starts the
algorithms from the 2010 Guidelines were translated by a volunteer in the UK and permission was obtained from
the UK Resuscitation Council (UK) to use them.
For the second and third trip Dr Cath Adams accompanied me to help with the training of female doctors. However
it turned out that women were quite happy to be trained by a man although they would not join in some practical
sessions. The recovery position seems very simple to us in the West and I was able to show the technique on a male
and expect them to practice it. However it turns out that the women would not do this as they considered it not
‘dignified’ to be seen lying on the floor.
Rumours soon spread around the hospital that we were practicing on dead bodies. Luckily we did enough training
in a short period of time to put the lie to this rumour.
Right at the start it became clear that many doctors struggled to identify a patient with symptoms of myocardial
infarction. Ask how they would deal with a gunshot wound to the neck with a compromised airway and they could
draw on a wealth of experience.
The internet via smart phones has reached Afghanistan. Consequently doctors have looked up resuscitation and
have all sorts of outdated information. One doctor was adamant that intra-cardiac adrenaline was recommended
and also said that pads could not be used. Paddles, using a firm pressure held the patient down and stopped them
jumping in the air.
Resuscitation on the children’s ward was frequent. We accept that the life of the mother is paramount in
resuscitation in pregnancy and childbirth. A common saying in Afghanistan is ‘a man can get another wife but
he can’t get another son.’ Many doctors do not accept this but they acknowledge that many of their patients and
relatives will think this.
Aftermath
Giving aid to another healthcare system is always difficult. The aim has to be capacity building with the students
building the system they will work in. It is very easy to fall into the spoilt child syndrome where you try to do
everything for them.
Having given the students the tools they now have to be left to it. Leadership and advice are still available to them
and email and Skype should ensure that they can be supported in their difficult task.
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National Cardiac Arrest Audit (NCAA) – Progress update 12
NCAA is the national clinical audit of in-hospital cardiac arrest with the aim of improving
resuscitation care and outcomes for the UK and Ireland. It is a joint initiative between the
Resuscitation Council (UK) and ICNARC (Intensive Care National Audit & Research Centre).
First clinical papers from NCAA!
Message from Dr Jerry Nolan (Chair, NCAA Steering Group)
We are delighted to announce that the first journal paper from NCAA entitled ‘Incidence and
outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit’
has been published online in the international journal Resuscitation.
A full version of the paper (together with my summary) is available for participating hospitals
to download from the NCAA secure online web portal (via File Exchange). If you do not
currently participate in NCAA and you would like to see a version of the paper, please contact
the NCAA team.
A subsequent paper entitled ‘Development and validation of risk models to predict outcomes following in-hospital
cardiac arrest attended by a hospital-based resuscitation team’ has also just been published online in the same
journal.
Thank you to all NCAA participants for their ongoing hard work collecting data which makes such important
research on in-hospital cardiac arrest possible. We anticipate that these papers will be the first of many generated
from NCAA!
Is YOUR hospital one of the remaining non-participants?
NCAA is listed in the Department of Health’s Quality Accounts (see the 2014/15 list), and as per the NCEPOD Report
‘Time to Intervene’ (June 2012), all acute hospitals are encouraged to participate in NCAA to collect structured data
on in-hospital cardiac arrests for their NHS Trust.
A total of 177 acute adult and children’s hospitals from all over the UK currently participate in NCAA and coverage
in England around 75% (for adult, acute hospitals)!
A list of participating and non-participating hospitals grouped by region is available to download. If your hospital
does not currently participate:
• Can ‘NCAA’ be added as an agenda item for your next resuscitation meeting?
• View the list of reasons why your hospital should participate and testimonials from hospitals on the benefits of
participating.
• What are the barriers (if any) to participating at your hospital? We would be interested to hear what these are.
• Need information to feed into a local business case for joining? NCAA can help with this.
• Want to know if we can come to your hospital to present on NCAA and answer any questions you may have?
Fourth NCAA Annual Meeting – 23 October 2014
The Fourth NCAA Annual Meeting is an opportunity to hear about the latest NCAA results and exciting NCAA
advancements, contribute to the development of this important national clinical audit, network with fellow
participants, as well as meet the NCAA team and NCAA Steering Group.
Each participating hospital is entitled to two places free of charge (one being for the Chair of the Resuscitation
Committee or their nominee). Hospitals keen to participate in NCAA are also welcome to join the meeting (for a
very small fee to cover costs only).
Registration is now open. For more information about the Forth NCAA Annual Meeting, please visit the ICNARC
website or contact the NCAA team: [email protected], 020 7269 9288.
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NCEPOD report ‘On the right trach?’ - A review by Carl Gwinnutt
In June this year the National Confidential Enquiry into Patient Outcome and Death
(NCEPOD) published their latest report ‘On the Right Trach?’ www.ncepod.org.
uk/2014report1/downloads/On%20the%20Right%20Trach_FullReport.pdf. This is a review
of the care of patients who underwent a new tracheostomy, either percutaneous, surgical
or laryngectomy. Patients were studied until decannulation or discharge from a critical care
area (with tracheostomy in place), decannulation, discharge from or at 30 days on a ward,
or death. Information about each case was sought by sending a questionnaire and a review
of selected case notes and the final report runs to 153 pages. The following is a personal
view of the important and interesting findings. As data is not complete for all cases, the
denominators vary and refer to the number of cases for which information is available.
Data returns
During the study period, 2755 cases were submitted, 2546 were included in the final analysis and 426 were
selected for a further detailed review by the assessors. The majority of tracheostomies were percutaneous (70%),
the age of patients ranged from 16 – 93 years, with a mean for both sexes of 61 years. The commonest reasons
for tracheostomy were; respiratory disease (35%), head and neck surgery (13%), neurological problems (13%),
abdominal aortic aneurysm surgery (12%) and cardiac surgery (6%). The majority of tracheostomies occurred
in emergency patients, 81% being ASA 3 and 4. Even though tracheostomy appears to be a relatively common
procedure, less than half the hospitals participating in the report could provide accurate numbers of how many
were performed annually and for all hospitals that replied the number ranged from 1 – 375.
Resuscitation policies
Despite the fact that tracheostomy is a known cause of adverse airway incidents, 20/217 hospitals had no
immediate access to a difficult airway trolley, while 47/209 had no immediate access to fibreoptic bronchoscopy.
Just over half the hospitals (116/215; 54%) had a resuscitation policy for patients with a tracheostomy whose
upper airway may still be patent, whilst less than half (97/214; 45.3%) had a resuscitation policy for patients
totally reliant on a stoma (i.e. following laryngectomy). The majority of hospitals (133/210; 63%) did not have
a resuscitation protocol for neck-breathers who presented as an emergency and only 62/217 (28.5%) hospitals
covered management of patients who are neck-breathers in mandatory resuscitation training.
Operator and consent
The vast majority of tracheostomies were performed by a Consultant or senior trainee. A consent form was only
available for 49% of percutaneous procedures (compared to 96% of surgically inserted tracheostomies) and a
‘WHO’ style checklist pre-procedure was performed in only 239/1490 (16%) of percutaneous procedures. Although
many of the percutaneous tracheostomies would have been performed on patients on a critical care unit (CCU)
who may have lacked capacity or required emergency treatment, Form 4 consent is designed for and should be
used in these circumstances.
Immediate complications occurred with a similar frequency following both percutaneous and surgical insertion
(approximately 5%). An adjustable length tracheostomy tube was used in only 10% of patients despite 25% of
them having a BMI of 30 - 40 and 5% a BMI greater than 40. Post insertion endoscopy was used in 51% of cases.
First change of tubes
Of tracheostomies inserted on a CCU, 113/419 (27%) were changed before day seven, (i.e. before an adequate
track had formed between skin and trachea), thereby significantly increasing the difficulty and risks of the
procedure. In 49/419 (11.7%) of patients on a CCU, tubes were changed after 30 days of insertion, again increasing
the risks, particularly from blockage and tracheal damage.
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Data for ward changes is limited suggesting that many patients did not undergo their first change on the ward. Of
those that did, 18.3% of patients had their first change within seven days of insertion and approximately 20% after
30 days.
Complications
A total of 461/1956 (24%) patients had defined complications whilst on a CCU, (e.g. infection, minor bleeding,
accidental displacement, obstruction). These were more likely to occur in the first seven days. Of the 185 patients
with major complications, (major bleeding, pneumothorax, accidental decannulation/displacement, obstruction)
in the majority (101) a Consultant was present within the first hour.
There was a greater overall incidence of complications amongst ward patients (173/553; 31.3%). Major
complications were less frequent, but accidental decannulation was slightly more common (4.1% v 6.3%), possibly
reflecting the greater activity and mobility of patients and/or lack of one-to-one nursing care. Despite these
findings, 28% of hospital sites declared they had no staff training in the management of blocked or displaced
tracheostomy tubes.
Of cases reviewed in detail by the assessors where there had been a complication, of 293 cases with sufficient data,
12 were considered to have suffered long term effects including hypoxia, myocardial ischaemia and sepsis.
Care of patients
In reviewing the care received by patients with tracheostomies, the Advisors felt that on a CCU, practice was
good in 40% patients; in cases where there was less than satisfactory care there were issues with clinical care, cuff
management, frequency of observations and the weaning process. Of ward patients, although the numbers were
smaller, the findings were very similar to those amongst CCU patients.
Principle recommendations
In the 11 week period of the study, 2755 cases of tracheostomy were reported of which 209 were excluded.
Extrapolating this data would indicate that around 12,000 tracheostomies are performed annually. If the findings
of this study are representative of practice, then there are significant numbers of patients being harmed, some
seriously, as they undergo tracheostomy. To reduce this morbidity and mortality the report makes a number of
recommendations, the key ones being:
1. All tracheostomy insertions should be recorded and coded as an operative procedure.
2. The diameter and length of the tube used should be appropriate for the size and anatomy of the individual
patient. This requires all units to stock an adequate range of tubes.
3. All Trusts should have a protocol and mandatory training for tracheostomy care including: guidance on
humidification, cuff pressure, monitoring, cleaning of inner cannula and resuscitation.
4. Tube data should be clearly recorded and available for review at the patient’s bedside. This could be facilitated
by a ‘passport’ for each patient containing all relevant data.
5. To facilitate decannulation and discharge, multi-disciplinary care should be established for all tracheostomy
patients with a daily review of all patients with a tracheostomy on a CCU.
6. Staff caring for tracheostomy patients must be competent in recognising and managing tube obstruction or
displacement. This should be in accordance with the guidelines issued by the National Tracheostomy Safety
Project (NTSP).
7. Unplanned and night-time discharge from a CCU is not recommended in patients which a newly formed
tracheostomy and/or recent weaning from respiratory support.
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National database of AED use - A report by Mick Colquhoun
The Resuscitation Council (UK) has been collecting AED use data since 1999 and published
initial results in ‘Resuscitation 2008 78 275-280’.
The Council has now published a further report covering the latest analysis of almost 3500
reports of AEDs deployed in the community being used by lay persons in a public access
defibrillation (PAD) role www.resus.org.uk/pages/Reports/Report-National_database_of_
AED_use.pdf
Management of cardiac arrest during neurosurgery in adults.
The Working Group of the Resuscitation Council (UK), in conjunction with Neuroanaesthesia
Society of Great Britain and Ireland, and Society of British Neurological Surgeons has
published a guide covering the management of cardiac arrest during neurosurgery
http://resus.org.uk/pages/CPR_in_neurosurgical_patients.pdf
Advanced Resuscitation of the Newborn (ARNI) manual
The first edition of the ARNI manual was published in May for the launch of the first course
in Leicester. The manual provides the material required for the ARNI course, however it is
also a useful resource for all neonatal care providers and can be used as a framework on
which to base practice.
We are offering all RC (UK) instructors the opportunity to buy a copy (or copies) at a
subsidised rate of £25 (rather than £40). If you are interested please contact
[email protected]
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