A reply

Abstract

Thank you for the interest in our article. Your comments are valid and survival figures are poor in this group. The study set out to ask a particular question in relation to NHBD rather than formally audit survival, but the figures reflect outcomes in the two centres. We recently audited outcomes of similar patients in other hospitals in our local ICU network (unpublished). The data show better survival rates than our series, but not as good as the figures cited. Cooling techniques were not in use at the time of the audits. The ICNARC dataset does not have a specific category for out-of-hospital arrest so the validity of figures from this source can be questioned. Different outcomes may be explained by a number of variables: The case mix of patients presenting after out-of-hospital cardiac arrest. The presence of significant comorbidities will limit survival even if initial resuscitation is successful. The age of our patients appears to be higher than in the series quoted and many patients had severe underlying medical problems. The timing and efficacy of bystander, paramedic, and Emergency Department resuscitation. The selection of resuscitated patients who are admitted to ICU as opposed to withdrawal of treatment in the Emergency Department or transfer to the Critical Care Unit or ward-based care. The two latter elements are likely to vary significantly between large and smaller hospitals. The scope of interventions in ICU including the recent interest in hypothermia. Decision making about withdrawal of treatment where the views of the patient (if known), families, medical and nursing staff are crucial. As with all patients with the potential for severe brain injury there is a difficult balance to be struck between offering the chance of recovery over time but also appreciating futility and the risk of patients surviving but with very limited neurological function.