Intended for healthcare professionals

Observations From the Heart

Improving the UK’s performance on survival after cardiac arrest

BMJ 2013; 347 doi: (Published 31 July 2013) Cite this as: BMJ 2013;347:f4800
  1. Aseem Malhotra, interventional cardiology specialist registrar,
  2. Roby Rakhit, consultant cardiologist and clinical director
  1. 1Royal Free Hospital, London
  1. aseem_malhotra{at}, roby.rakhit{at}

The evidence base is strong for changing the way we treat people who have had a cardiac arrest outside hospital

On 17 March 2012 the premier league footballer Fabrice Muamba, who played for Bolton, had a cardiac arrest during an FA cup clash against Tottenham Hotspur at White Hart Lane, in north London. Given the estimated resuscitation time of over an hour and his discharge from a London hospital four weeks later with no neurological deficit, it is not surprising that many described his recovery as “miraculous.” Current UK survival rates among people who have a cardiac arrest outside hospital remain extremely poor, varying from 2% to 12%.1 Every year an estimated 60 000 out of hospital cardiac arrests occur in the UK, 30 000 of which are treated by emergency medical services.2 3

Optimal use of the “chain of survival” (the sequence of interdependent treatment actions for cardiac arrest), as occurred with Muamba, is what makes the difference between life and death. Predictors of survival include time to the first emergency response; whether the arrest is witnessed; effective bystander cardiopulmonary resuscitation (CPR); initial shockable rhythm; early defibrillation; and pre-hospital return of spontaneous circulation.4 Although the links within this chain of survival are paramount, early defibrillation is …

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