Elsevier

Resuscitation

Volume 64, Issue 1, January 2005, Pages 13-19
Resuscitation

Cardiopulmonary resuscitation standards for clinical practice and training in the UK,☆☆,

https://doi.org/10.1016/j.resuscitation.2004.11.001Get rights and content

Abstract

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document 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 makes several recommendations. 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.

Introduction

Healthcare institutions have an obligation to provide an effective resuscitation service and to ensure that their staff receive training and regular updates for maintaining a level of competence appropriate to each individual's employed role. This requires appropriate equipment for resuscitation, training in resuscitation, managerial and secretarial support, financial planning, and continual reappraisal of standards and results. Failure to provide an effective service is a failure in duty of care that is a clinical risk, contravenes the principles of clinical governance, and has implications for clinical negligence premiums.

As outcome from cardiac arrest remains poor, an important aspect of an institution's resuscitation planning is the delivery of timely and effective treatment to make it less likely that critically ill patients deteriorate to the point of cardiopulmonary arrest.

This document provides guidelines for clinical practice and training for those with a responsibility for resuscitation services within healthcare institutions. The document builds on previous reports from the Royal College of Physicians, the Royal College of Anaesthetists, the British Medical Association, the Royal College of Nursing, and the Resuscitation Council (UK).

Throughout this document the term ‘healthcare institution’ is used. While the guidance contained is directed to all institutions where clinical patient care is undertaken the term is applicable mainly to hospitals admitting acutely ill patients. Healthcare institutions need to base their resuscitation service on a detailed and documented risk assessment for their sites.

Section snippets

Recommendations

  • (1)

    Healthcare institutions should have, or be represented on, a resuscitation committee that meets regularly, e.g., quarterly, and whose purpose is to ensure clear leadership of the resuscitation service.

  • (2)

    Essential members of the resuscitation committee include a physician, the senior resuscitation officer, an anaesthetist /intensivist, and a senior manager. Representation from other departments, e.g., emergency medicine, paediatrics, cardiology, obstetrics, pharmacy, nursing, general practice,

Recommendations

  • (1)

    Every institution should have at least one person, the resuscitation officer (RO), who is responsible for co-ordinating the teaching and training of staff in resuscitation. This person may have additional responsibilities, e.g., audit, or maintenance of clinical equipment.

  • (2)

    Depending on the size and geographical distribution of the institution, more than one RO may be needed to fulfil training requirements and additional responsibilities relating to resuscitation. Typically, one RO is required

Recommendations

  • (1)

    Staff should undergo regular resuscitation training to a level appropriate for their expected clinical responsibilities.

  • (2)

    Training staff to recognise patients at risk of cardiopulmonary arrest, and to start treatment to prevent cardiopulmonary arrest, is an important component of improving survival in critical illness.

  • (3)

    Training should be provided in the use of an ”early warning scoring” system to identify patients who are critically ill and therefore at risk of cardiopulmonary arrest.

  • (4)

    Training must

Recommendations

  • (1)

    An early warning scoring system should be in place to identify patients who are critically ill and therefore at risk of cardiopulmonary arrest.

  • (2)

    The institution should have a designated outreach service or medical emergency team (e.g., MET) capable of responding to acute clinical crises identified by clinical triggers or other indicators.

  • (3)

    The institution should have a patient charting system that facilitates the regular measurement and recording of early warning scores.

  • (4)

    The institution should have

Recommendations

The institution should have a team that is activated in response to a cardiopulmonary arrest. Ideally, the team should include at least two doctors with current training in advanced life support. The exact composition of the team will vary between institutions, but overall the team must have the following skills:

  • airway interventions, including tracheal intubation;

  • intravenous cannulation, including central venous access;

  • defibrillation (advisory and manual) and cardioversion;

  • drug administration;

Recommendations

Special conditions apply to the resuscitation of children, pregnant patients and the victims of trauma. The cause of the cardiopulmonary arrest and the techniques of resuscitation may differ. In all cases it is imperative that staff with the appropriate experience are present at the resuscitation attempt.

Recommendations

  • (1)

    The choice of resuscitation equipment should be defined by the resuscitation committee and will depend on the anticipated workload, availability of equipment from nearby departments and specialised local requirements.

  • (2)

    Ideally, the equipment used for cardiopulmonary resuscitation (including defibrillators) and the layout of equipment and drugs on resuscitation trolleys should be standardised throughout an institution.

  • (3)

    Staff must be familiar with the location of all resuscitation equipment within

Recommendations

  • (1)

    It is essential to identify (a) patients for whom cardiopulmonary arrest is an anticipated terminal event and in whom cardiopulmonary resuscitation (CPR) is inappropriate; and (b) patients who do not wish to be treated with CPR.

  • (2)

    All institutions should ensure that there is a clear and explicit resuscitation plan for all patients. For some patients this will involve a DNAR decision. Such decisions are complex clinically, ethically and emotionally. National guidelines from the British Medical

Recommendations

  • (1)

    Immediately after resuscitation, most patients are clinically unstable and likely to require admission to a coronary care or critical care unit; this will depend on factors such as previous health, severity of illness, and underlying diagnosis. Facilities for continuing care may not be available where the cardiopulmonary arrest occurred; transfer of the patient may be necessary.

  • (2)

    Continuity of care during this period is vital. Senior staff should be involved before transfer. When appropriate,

Recommendations

  • (1)

    To ensure a high quality resuscitation service the institution should audit:

    • the availability and use of equipment (variable frequency);

    • the availability of cardiopulmonary arrest and peri-arrest drugs (variable frequency);

    • all cardiopulmonary arrests using the principles of the Utstein template (each event);

    • resuscitation decisions / DNAR (each event). Audit of DNAR policies is mandatory (Health Services Circular 2000/028);

    • cardiopulmonary arrest outcomes (each event);

    • critical incidents leading to

Recommendations

  • (1)

    Research is needed to improve the resuscitation service. Individuals who wish to further the scientific basis and clinical practice of resuscitation should be encouraged.

  • (2)

    Clinical research in this area is challenging, not least because of the ethical issues raised. Individuals wishing to undertake research in resuscitation are advised to seek the advice and support of their local research ethics committees.

Acknowledgements

Dr Neville Goodman for editing the text, Dr. Harry Walmsley and Dr. Jane Pateman for their contributions to the Resuscitation Council (UK) “Guidance for Clinical Practice and Training in Hospitals”, published in 2000.

Glossary

AED
Automated External Defibrillator
ALS
Advanced Life Support
APLS
Advanced Paediatric Life Support
ATLS
Advanced Trauma Life Support
CPR
Cardiopulmonary Resuscitation
DNAR
Do Not Attempt Resuscitation
EPLS
European Paediatric Life Support
MET
Medical Emergency Team
NLS
Newborn Life Support
RO
Resuscitation Officer
SAD
Shock Advisory Defibrillator

References (0)

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A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at 10.1016/j.resuscitation.2004.11.001

☆☆

This document has been endorsed by: The Council for Professionals as Resuscitation Officers, The National Patient Safety Agency, The Royal College of Physicians of Edinburgh, The Royal College of Physicians and Surgeons of Glasgow, The Royal College of Surgeons of England, The Royal College of Surgeons of Edinburgh, The Royal College of Paediatrics and Child Health, The Royal College of Nursing, The Faculty of Accident and Emergency Medicine.

★ A joint statement from: The Royal College of Anaesthetists, The Royal College of Physicians of London, The Intensive Care Society, The Resuscitation Council, UK.

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