Resuscitation Council UK Research Articles

Emergency treatment of peri-operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists.

Peri-operative anaphylaxis is a rare but potentially catastrophic event which must be considered whenever unexpected and significant cardiovascular or respiratory compromise occurs during anaesthesia. The Resuscitation Council UK algorithm for peri-operative anaphylaxis highlights the importance of early intravenous adrenaline and fluid resuscitation and provides guidance on the treatment of refractory anaphylaxis and immediate follow-up. This algorithm is endorsed by the Royal College of Anaesthetists, Association of Anaesthetists, British Society of Allergy and Clinical Immunology and Clinical Immunology Professional Network of the British Society for Immunology. This document was produced by the Perioperative Allergy Network steering committee in collaboration with the Resuscitation Council UK.

A82‘Simulation for Finals and Real Life’ – is it ever too early to jump in the deep end?

Surveying University of Nottingham (UoN) medical students in their final year with regards to applying an A-E approach in a medical emergency context, we found that they lacked confidence. In order to address this curriculum gap, we designed a low-fidelity simulation-based workshop which has been shown to improve confidence in developing key skills relating to medical emergencies [1]. This consists of a 2-hour session for groups of 6, for all students undertaking their medical placements at Nottingham University Hospitals (NUH). After successfully implementing this workshop for students in their final year, we asked ourselves ‘when is it too early for medical students to cover A-E assessments in medical training?’ Considering this is an essential skill to develop and part of their intended learning outcomes (ILOs) that is also tested in their 3rd year examinations, we introduced an adapted version of this workshop for the more junior cohort. We constructed this workshop with alignment to both the final and third year UoN curriculum ILOs. Google forms were used to survey students’ confidence pre and post-session. We used a low-fidelity simulation mannequin, focusing on an otherwise realistic clinical environment using medical notes, a portfolio of investigations and props. This included an observation monitor, a real-time display with altering vital parameters and a fully equipped emergency trolley. Pre‐reading handouts on A-E assessment by the Resuscitation Council UK [2] were provided. We watched a pre‐recorded demonstration video of the management of hypoglycaemia prior to students working in pairs on three scenarios. During the simulation scenarios, faculty members acted as either the patient or team members, including as a nurse and medical registrar. We showed that participation in our workshop significantly improved student confidence in the specific domains (see Summary of the student questionnaire results Written feedback from students suggested active participation in a simulated learning environment together with a detailed debrief and facilitated discussion was a powerful learning experience. This workshop has now been embedded into the teaching timetable at NUH. A-E assessment is a key template doctors of all grades use when facing the most critical situations. Considering the feedback, introducing more junior students to the structure of an A-E assessment early is essential for creating a scaffold in their long-term memory, ingraining this into their professional practice. This will prepare them for their OSCEs and the new GMC mandated MLA examinations [3] and, more importantly, for when they start their roles as foundation doctors. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A31Skills2u – using ward-based toolkit training to address frequently identified technical skills performance errors during <i>in situ</i> simulation

Delayed airway management was identified in 70% (9 of 13) of Insitu simulation (ISS) with an average time of 3.42 minutes from identification of the problem to management. The resuscitation council UK suggest that in most patients presenting with a compromised airway, simple actions are sufficient to stabilize them, failing to do so increases the risk of hypoxia and multi-organ failure [1]. To address this trust wide training was initiated through the ‘skills2u’ programme, where toolbox teaching was taken to the wards. Across a two-week period, a multiprofessional team comprising of the simulation faculty, anaesthetists, and advanced clinical practitioners, visited all clinical areas and delivered a short 10–15-minute practical ward-based interactive session to the interprofessional team. The session covered airway assessment, airway opening manoeuvres and opportunity to practice inserting basic airway adjuncts. 412 clinical staff, of all grades and disciplines, were taught in basic airway management of the deteriorating and arrested patient. Evaluation of the teaching revealed 95.5% of staff agreed it was relevant to their role and 98% agreed they now felt better prepared to respond to changes in a patient’s condition. In the subsequent three months, technical skills performance errors for airway management were identified in 15% of 10 ISS completed. In these simulations the average time taken to manage the airway from identification of the problem reduced to 1.39 minutes. Using ISS to identify technical skills performance errors followed by a trust wide ward-based education programme is an effective way to enhance patient safety. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Automated external defibrillator location and socioeconomic deprivation in Great Britain

ObjectiveThe early use of automated external defibrillators (AEDs) improves outcomes in out-of-hospital cardiac arrest (OHCA). We investigated AED access across Great Britain (GB) according to socioeconomic deprivation.MethodsCross-sectional observational study using...

FTP6.1 A little respect! A closed-loop audit increasing awareness of ReSPECT forms in a busy general surgical department

Abstract Aims ReSPECT forms have been introduced by Resuscitation Council UK to provide recommendations for patients’ emergency care. The primary aim of the audit was to assess the completion rate of ReSPECT forms on a busy surgical ward. Secondly, the audit aimed to both increase the awareness and the completion rate of ReSPECT forms. Methods Data was collected in the form of random spot-checks of completed ReSPECT forms for all general surgical inpatients at our general hospital. The first intervention involved the addition of a column to the surgical ‘take’ list to highlight the presence or absence of ReSPECT forms. Team education using a novel poster, prioritising the urgency of completion of ReSPECT forms dependent on patient’s co-morbidities, and a teaching session was the intervention for the second cycle. Results The initial completion rate of accurate ReSPECT forms was 31%. Following the first intervention the ‘ReSPECT column’ on the list had been completed for 15% of inpatients and the overall completion rate of ReSPECT forms was 35%. After the ReSPECT poster and teaching the usage of the ‘ReSPECT column’ increased to 39% and overall completion rate was 33%. Conclusions The addition of a column to the acute, surgical list was a simple and effective way of increasing awareness of completed ReSPECT forms. Increased compliance may be achieved by finding more efficient methods of monitoring completion. Overall completion of ReSPECT forms had improved with the interventions, however, due to the high turnover of surgical patients, there are still further improvements possible.

A step-by-step guide to DNACPR from the Resuscitation Council UK

Resuscitation Council UK ReSPECT (Recommended summary plan for emergency care and treatment) clinical lead Catherine Baldock and legal adviser for the ReSPECT process Alex Ruck Keene KC (Hon) answer some of the questions most commonly asked about do not attempt cardiopulmonary resuscitation (DNACPR) recommendations.

A step-by-step guide to DNACPR from the Resuscitation Council UK

Expert advice to help in understanding the scope of do not attempt cardiopulmonary resuscitation recommendations, capacity and advance decisions to refuse treatment

Guideline on the investigation and management of acute transfusion reactions.

Guideline on the investigation and management of acute transfusion reactions.

A step-by-step guide to DNACPR from the Resuscitation Council UK

Advice to help you understand do not attempt cardiopulmonary resuscitation recommendations

Step-by-step guide to issues around DNACPR

A Q&A with experts from the Resuscitation Council UK, to help you navigate the complex decision-making associated with DNACPR recommendations, capacity and advance decisions to refuse treatment

Surviving an out-of-hospital hypothermic cardiac arrest in the United Kingdom.

Hypothermia is an uncommon cause of cardiac arrest in the United Kingdom, and more commonly occurs in countries experiencing avalanches and significant winter climates; however, this case demonstrates that the presentation can occur in the United Kingdom. This case adds to a body of evidence that prolonged resuscitation can be successful in patients suffering a cardiac arrest secondary to hypothermia, leading to a good neurological outcome. The patient suffered a witnessed out-of-hospital cardiac arrest following rescue from a free-flowing river, and underwent prolonged resuscitation. The patient presented in persistent ventricular fibrillation, unresponsive to defibrillation attempts. An oesophageal probe recorded the patient's temperature as 24°C. Rescuers were guided by the Resuscitation Council UK advanced life support algorithm to withhold drug therapy and limit defibrillation attempts to three, until the patient had been rewarmed to above 30°C. Appropriate triage of the patient to an extracorporeal life support (ECLS) capable centre allowed specialised treatment to be initiated, and culminated in successful resuscitation once normothermia was restored. After a short stay in intensive care, the patient was discharged for rehabilitation due to a hypoxic spinal cord injury before discharge home. This case highlights that hypothermia is a reversible cause of cardiac arrest, which needs to be recognised and acted upon appropriately to provide the best possible chance for a positive outcome. Low-reading thermometers capable of identifying the temperature thresholds stated in the Resuscitation Council UK guidelines are required, to allow clinicians to adapt their practice according to the presenting situation. Tympanic thermometers are often limited to their lowest recordable temperature, and invasive monitoring such as oesophageal or rectal probes are not common in UK ambulance service practice. With the necessary equipment, patients can be triaged to an ECLS-capable centre, allowing them to receive the specialist rewarming that they require.

The knowledge of infant CPR among parents visiting Maternity and Children Hospital (MCH) in Al –Ahsa, Saudi Arabia

Background: CPR (cardiopulmonary resuscitation) is a medical procedure that anyone can learn which can help to save a life in the event of a medical emergency. Resuscitation Council UK report that for every minute that a person in cardiac arrest does not receive CPR its survival chance drops by up to 10%. However, an inadequate public awareness and knowledge of infant and pediatric CPR have been documented. Therefore, parents and caregiver should be educated about infant CPR which can help in correctly implementing it and save the life of infant. This study was conducted on the mothers attending the MCH for the baby care is to assess their knowledge on infant CPR skill. Material and methods: This was a Cross sectional study conducted at Maternity and Children Hospital (MCH) in AL- Ahsa. All the parents visiting MCH with their children for the treatment were the study population. The website Raosoft was used to calculate the sample size (n=284). Convenient sampling technique was used to collect the sample. Pretested and predesigned self-reported questionnaire from the previous regional study was distributed to the selected sample participants. The data were entered and analyzed by using the SPSS; version 21. Descriptive statistics were presented using counts, proportions (%), mean ± standard deviation whenever appropriate. Descriptive statistics (e.g. number, percentage) and analytic statistics using Chi Square tests (χ2) to test for the association and/or the difference between two categorical variables were applied. A p-value equal to or less than 0.05 was considered statistically significant. Results: A total of 254 out of 284 subjects responded the questionnaires. The mean age of the participants was 38.65 years ± Std. Dev. 9.90 years .The majority of the participants (61.0%) were graduate Almost sixteen percent (15.7%) of the participants had family history of heart disease. Fifty percent of the participants had attended the CPR course. An overwhelming majority of the participants (87.0%) were willing to take a short course of infant CPR if it is available in MCH. The mean knowledge sore in infant CPR of the participants was 2.42 ± Std.Dev.1.33 (Range 00-6). More than forty one percent of the participants had poor knowledge regarding Infant CPR while 58.7% had good knowledge. As educational qualification increased the percent of good knowledge significantly also increased .The participants who did not have the family history of cardiac disease were having significantly good knowledge about infant(P=0.01).Those participants who had attended infant CPR course had significantly higher knowledge score than those who did not attend the infant CPR course (76.37% vs.40.94%, P=0.000) Those participants who were not willing to take a short course of infant CPR had significantly better knowledge score on infant CPR as compared to those participants who were willing to join the course on infant CPR (69.69% vs.57.01%,P=0.021). Conclusion: The present study has shown a better knowledge among the females regarding infant CPR as compared to other studies conducted in Saudi Arabia. The participants in this study were found very motivated to learn the skills of infant CPR. However there is a need to develop programmers for teaching the infant CPR to the mothers at all level of health care facility attending the MCH, Al Ahsa.

The nationwide impact of COVID-19 on life support courses. A retrospective evaluation by Resuscitation Council UK

AimTo determine the impact of the COVID-19 pandemic on Resuscitation Council UK Advanced Life Support (ALS) and Immediate Life Support (ILS) course numbers and outcomes. MethodsWe conducted a before-after study using course data from the Resuscitation Council UK Learning Management System between January 2018 and December 2021, using 23 March 2020 as the cut-off between pre- and post-pandemic periods. Demographics and outcomes were analysed using chi-squared tests and regression models. ResultsThere were 90,265 ALS participants (51,464 pre-; 38,801 post-) and 368,140 ILS participants (225,628 pre-; 142,512 post-). There was a sharp decline in participants on ALS/ILS courses due to COVID-19. ALS participant numbers rebounded to exceed pre-pandemic levels, whereas ILS numbers recovered to a lesser degree with increased uptake of e-learning versions. Mean ALS course participants reduced from 20.0 to 14.8 post-pandemic (P < 0.001).Post-pandemic there were small but statistically significant decreases in ALS Cardiac Arrest Simulation Test pass rates (from 82.1 % to 80.1 % (OR = 0.90, 95 % CI = 0.86–0.94, P < 0.001)), ALS MCQ score (from 86.6 % to 86.0 % (mean difference = -0.35, 95 % CI −0.44 to −0.26, P < 0.001)), and overall ALS course results (from 95.2 %to 94.7 %, OR = 0.92, CI = 0.85–0.99, P = 0.023). ILS course outcomes were similar post-pandemic (from 99.4 % to 99.4 %, P = 0.037). ConclusionCOVID-19 caused a sharp decline in the number of participants on ALS/ILS courses and an accelerated uptake of e-learning versions, with the average ALS course size reducing significantly. The small reduction in performance on ALS courses requires further research to clarify the contributing factors.

1342 DO NOT ATTEMPT CONVERSATIONS PRE-REHEARSAL: TEACHING MEDICAL STUDENTS TO HAVE DNACPR CONVERSATIONS

Abstract Introduction The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form is widely adopted to document advanced care plans, including Do Not Attempt Resuscitation (DNACPR) decisions. Communication between clinicians and patients, or next of kin is required for completion. It is widely documented UK medical students have little exposure to these experiences, including being asked to leave whilst they are occurring. During the COVID19 pandemic, Foundation Year 1 (FY1) doctors led discussions with increased frequency and autonomy, with no documented concurrent training. We present a novel learning experience designed to aid these discussions. Students were timetabled to a 1.5 hour workshop, facilitated by a clinical teaching fellow. They were invited to complete ReSPECT form for a celebrity to familiarise themselves with the layout. They then considered a patient admission scenario in 3 different groups from the perspective of the patient, family and medical team, and used this to contemplate potential, future, emergency treatments. Subsequently a discussion surrounding CPR effectiveness, ways of communicating this, and legal advanced decision documents occurred. The session concludes with scrutinising example ReSPECT forms provided by the Resuscitation Council UK. Method Students' confidence levels were measured pre and post session using a Likhert scale questionnaire. Results 90 students attended workshops across 6 rotations. 80% students completed post - session questionnaires, of which 100% reported an increase in confidence with having a DNACPR/advanced care planning discussion compared to before the session. Conclusion DNACPR conversations can incite anxiety in any seniority of health care professionals. Medical educators need to adequately prepare medical students during their training in advanced care planning and DNACPR discussions. This can be done with simulated workshop experiences, reinforced with opportunistic or organised observational experience. Adequate preparation will lead to increased confidence in discussions, ultimately leading to better experiences for patients and their families.

Management of choking

Choking is the result of a sudden obstruction, partial or complete, of the airway due to a foreign body stuck in any portion of the airway. There are numerous causes of choking, including food, tablets or toy parts, to name but a few. It can be traumatising for the suffering patient and anyone witnessing the event. As GPs, we undergo mandatory basic life support training to help in recognition of the acute respiratory symptoms associated with choking and to aid more expert management of choking. This article is intended to be used only in conjunction with learning from mandatory basic life support training and action taken should follow the latest Resuscitation Council UK guidance, sequential basic life support and algorithms.

A quality improvement project (QIP) on the awareness of the revised anaphylaxis guidelines identified through simulation

Anaphylaxis is an important emergency which forms part of the adult Advanced Life Support guidelines. The guidelines for anaphylaxis have recently undergone a change in the 2021 revision, with steroids and antihistamine no longer advised for acute anaphylaxis and an adrenaline infusion included as part of the new refractory anaphylaxis algorithm [1]. Scenarios for the medical trainees run at our simulation centre identified a lack of awareness of the revised anaphylaxis guidelines among learners. A QIP was completed to improve the level of learners’ awareness and confidence of the revised anaphylaxis guidelines in conjunction with the simulation team. Online surveys were sent out to the medical registrars and internal medicine trainees regarding the revised anaphylaxis guidelines. This was followed by an email sent two weeks later with the revised guidelines highlighting key changes. The same group were subsequently re-surveyed two weeks following the intervention to identify changes in clinical practice. Concurrently, scenarios based on the revised anaphylaxis guidelines were run for the medical trainees with specific emphasis on whether trainees were aware of the need for an adrenaline infusion (managed in a specialist setting) if symptoms were ongoing despite two IM doses of adrenaline. In the post-simulation debriefing, discussion was focused on the change in the anaphylaxis guidelines. In the first cycle, 100% of 23 respondents felt confident managing anaphylaxis but only 50% of respondents were aware (and were confident) that the guidelines had been revised. 2/3 of respondents had not managed a case of anaphylaxis in the last 12 months. In the second cycle, 100% of 4 respondents were aware of the revised guidelines but only 75% of respondents were confident in following the guidelines. 75% of respondents had not managed a case of anaphylaxis in the last 12 months. The significant drop in number of responders is likely to be multifactorial but may reflect a change in focus of educational needs due to the ongoing COVID-19 pandemic leading to a change in the educational landscape. A survey done on the attitude of medical students during the COVID-19 pandemic towards online learning found that only 54.1% of respondents felt that interactive discussion could occur through e-learning [2]. Following the QI results, the cardiac arrest trolleys were checked and the emergency box with adrenaline now includes the revised anaphylaxis algorithm but not hydrocortisone and chlorphenamine. Refractory anaphylaxis is now a standard scenario for the medical trainees in our simulation centre. 1. Resuscitation Council UK. Emergency treatment of anaphylaxis: Guidelines for healthcare providers. 2021. 2. Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H, Ashini A, Ashwieb A, Ghula M, Ben Hasan H, Abudabuos S, Alameen H, Abokhdhir T, Anaiba M, Nagib T, Shuwayyah A, Benothman R, Arrefae G, Alkhwayildi A, Alhadi A, Zaid A, Elhadi M. Impact of the COVID-19 pandemic on medical education: Medical students’ knowledge, attitudes, and practices regarding electronic learning. PLoS One. 2020;15(11):e0242905.

Emergency treatment of anaphylaxis: concise clinical guidance

Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. It is characterised by the rapid development of airway and/or breathing and/or circulation problems. Intramuscular adrenaline is the most important treatment, although, even in healthcare settings, many patients do not receive this intervention contrary to guidelines. The Resuscitation Council UK published an updated guideline in 2021 with some significant changes in recognition, management, observation and follow-up of patients with anaphylaxis. This is a concise version of the updated guideline.

Availability and Functionality of Physical Health and Resuscitation Equipment in an Inpatient Setting: A Closed Loop Audit Cycle

AimsTo ensure physical health and resuscitation equipment on all wards in a mental health hospital fulfil relevant standards. A closed-loop audit of this was performed on four acute adult inpatient wards after implementing interventions.MethodsData were collected from treatment rooms on each ward, with standards based on Physical Health in Mental Health; Final Report of a Scoping Group (Royal College of Psychiatrists) and Mental Health Inpatient Care Equipment and Drug Lists (Resuscitation Council UK) – parallel to the trust approved standards.Percentage of availability and functionality against audit standards were tabulated and interventions were carried out, including: 1.Awareness presentations at trust clinical governance meetings.2.Each ward to have own complete sets of physical health and resuscitation equipment.3.Policy for wards to register their physical health equipment and service details on the trust maintenance services database. The medical device engineering team to complete maintenance and repair as needed.4.Resuscitation equipment on each ward being checked weekly and replaced as needed (monthly before).A re-audit was performed one year post intervention on four acute adult inpatient wards in the mental health hospital using similar parameters.Results1.In general, 90.0% of the standards are met (out of 160 pieces of equipment, 144 are in stock and functional), similar to that of previous year (90.0%).2.Decrease in overall available and functional physical health equipment: 76.6% (49/64) compared to 83.8% last year.3.Increase in overall in overall available and functional resuscitation equipment: 99.2% (95/96) compared to 94.2% last year.ConclusionThere is a significant decrease in percentage of overall available and functional physical health equipment; while that of resuscitation equipment has significantly improved when checked and corrected weekly using the trust Resuscitation Check Form.Action plan: 1.All unavailable/ inadequate equipment to be reordered or sent for maintenance immediately.2.Discussion in the upcoming trust Physical Health Nurses Forum and Medical Devices Standards Group on audit recommendations below: . Allocation of named permanent staff member to check presence and functionality of medical equipment regularly.a. Creating a checklist similar to the Resuscitation Check Form for physical health equipment.3.Discussion in the trust Resus Standards Group on ‘My Kit Check’ (MKC), a centrally monitored electronic checking platform with alerts automatically sent for incomplete checks or expired resuscitation items (e.g., AED batteries, anaphylaxis kit) that are not replaced. A funding request has been submitted for this.

Y03 The nationwide impact of COVID-19 on Advanced Life Support courses. A retrospective evaluation by Resuscitation Council UK

Y03 The nationwide impact of COVID-19 on Advanced Life Support courses. A retrospective evaluation by Resuscitation Council UK

‘Resuscitation Council UK Guidelines 2021’ – a short commentary

New Resuscitation guidelines have been published this year by Resuscitation Council UK (RCUK). Its the commentary and comparison of changes to the previous guidelines of BLS, ALS, PLS and PALS The new topics are also added in new guidelines and details are in full text Key words: OHCA: out of hospital cardiac arrest, IHCA: in hospital cardiac arrest. BLS: Basic life support, ALS : advanced life support PLS: Pediatric life support PALS: pediatric advanced life support Abbreviations: CPR–Cardiopulmonary resuscitation; OHCA–Out-of-hospital cardiac arrest; IHCA–In-hospital cardiac arrest; PEA–Pulseless electrical activity; ROSC–Return of spontaneous circulation; ILCOR–International Liaison Committee on Resuscitation; NICE–National Institute for Health and Care Excellence Citation: Amjad MA, Ahmad F, Rai R, Durrani RS. ‘Resuscitation Council UK Guidelines 2021’ – a short commentary. Anaesth. pain intensive care 2021;25(4):519–522. DOI: 10.35975/apic.v25i4.1584. Received: June 13, 2021, Reviewed: June 26, 2021, Accepted: June 31, 2021