APPENDIX 4
Memorandum by Dr Michael Colquhoun (GP05)
SUMMARY: RECOMMENDATIONS
Cardiac arrest is a common complication of acute
myocardial infarction (heart attack). Resuscitation by general
practitioners has been proved to be a very effective strategy
to manage the condition. All general practitioners and others
who provide emergency medical care should be equipped and trained
to use a defibrillator so that they may resuscitate patients who
experience a cardiac arrest in the community.
1. I write on behalf of the Resuscitation
Council (UK) to advise the Health Committee about the importance
of resuscitation in General Practice and to those providing out-of-hours
services. The Resuscitation Council (UK) is the recognised medical
advisory body on the subject of resuscitation in the UK. Its Members
also hold key positions on the European Resuscitation Council
and have a central role in the formulation of international resuscitation
guidelines.
2. Cardiac arrest commonly complicates the
early stages of acute myocardial infarction (AMI), and is responsible
for about 90,000 premature deaths every year in the UK. Many of
these patients can be resuscitated by defibrillation (the application
of an electrical countershock from a defibrillator) and subsequently
have many years of normal life. Treatment is critically time dependent
however; and chances of successful resuscitation decline by about
10% with every minute that defibrillation is delayed. This is
recognised in the NSF on Coronary Heart Disease and provides the
principle reason for Standard Five, "People with symptoms
of a possible heart attack should receive help from an individual
equipped with and appropriately trained in the use of a defibrillator
within eight minutes of calling for help, to maximise the benefits
of resuscitation should it be necessary."
3. The British Heart Foundation (BHF) has
supplied defibrillators to many General Practitioners and a database
on their use has been operating since 1985. This now contains
several hundred records of resuscitation attempts in General Practice.
Modern automated external defibrillators are compact, lightweight
and require minimal training to use. Their price has fallen considerably
in recent years; models are available costing around £1,500
with an expected life span of seven—10 years.
4. General Practitioners each see on average
three—five cases of AMI per annum (approximately 150,000
patients) and there are three clinical studies in the scientific
literature that show that approximately 5% of such patients suffer
a cardiac arrest in the presence of their doctor.
5. The British Heart Foundation (BHF) statistics
testify overwhelmingly to the success of defibrillation by general
practitioners, with approximately 65% of patients who arrest in
the presence of the doctor leaving hospital alive provided the
doctor has a defibrillator. If the doctor attends within five
minutes resuscitation rates are still excellent with nearly 60%
surviving. When cardiac arrest occurs on surgery premises approximately
75% of patients are subsequently discharged from hospital alive
provided a defibrillator is rapidly available. This evidence is
based on original work performed by myself in conjunction with
the BHF.
6. BHF statistics from the minority of GPs
who carry defibrillators testify to their effectiveness with records
of approximately 150 patients who have survived cardiac arrest
outside hospital. The very high success rate quoted is one of
the best reported for any group of healthcare provider. To put
this further into perspective, ambulance services in England resuscitate
approximately 2% of all the cases of cardiac arrest that they
attend.
7. These findings have been described in
scientific medical literature but are not widely known outside.
I would certainly be willing to give oral evidence on this subject
if that were helpful to the Committee.
8. The recommendation that stems from the
evidence is clear: all those who provide out-of-hours care for
this vulnerable group of patients should be trained and equipped
to defibrillate. Many patients who might otherwise die prematurely
will be saved.
May 2004
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