The UK Out of Hospital Cardiac Arrest Outcome (OHCAO) project

Abstract

Introduction: Reducing premature death is a key priority for the UK National Health Service (NHS). NHS Ambulance services treat approximately 30 000 cases of suspected cardiac arrest each year but survival rates vary. The British Heart Foundation and Resuscitation Council (UK) have funded a structured research programme--the Out of Hospital Cardiac Arrest Outcomes (OHCAO) programme. The aim of the project is to establish the epidemiology and outcome of OHCA, explore sources of variation in outcome and establish the feasibility of setting up a national OHCA registry.

Methods and analysis: This is a prospective observational study set in UK NHS Ambulance Services. The target population will be adults and children sustaining an OHCA who are attended by an NHS ambulance emergency response and where resuscitation is attempted. The data collected will be characterised broadly as system characteristics, emergency medical services (EMS) dispatch characteristics, patient characteristics and EMS process variables. The main outcome variables of interest will be return of spontaneous circulation and medium-long-term survival (30 days to 10-year survival).

Ethics and dissemination: Ethics committee permissions were gained and the study also has received approval from the Confidentiality Advisory Group Ethics and Confidentiality committee which provides authorisation to lawfully hold identifiable data on patients without their consent. To identify the key characteristics contributing to better outcomes in some ambulance services, reliable and reproducible systems need to be established for collecting data on OHCA in the UK. Reports generated from the registry will focus on data completeness, timeliness and quality. Subsequent reports will summarise demographic, patient, process and outcome variables with aim of improving patient care through focus quality improvement initiatives.

Keywords: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY; STATISTICS & RESEARCH METHODS.

Figure 1

Funnel plot showing percentage return of spontaneous circulation (A) and survival to hospital discharge (B) against the total number of cardiac arrests where resuscitation was attempted. Each dot represents a single ambulance service. Variation within the dotted line boundaries are considered to be due to normal or common-cause variation. Those lying outside the dotted line represent cases of special cause variation.

Figure 2

Sources of special cause variation in cardiac arrest likely to influence survival rates adapted from Lilford et al. EMS, emergency medical services.