Cardiopulmonary Resuscitation Policy
(Including Anaphylaxis and Defibrillation)
Version
13
Name of responsible (ratifying)
committee
Resuscitation Committee
Date ratified
24th April 2014
Document Manager (job title)
Resuscitation Manager
Date issued
25th April 2014
Review date
24th April 2017 (unless requirements change)
Electronic location
Clinical Policies
Related Procedural Documents
Do Not Attempt Cardiopulmonary Resuscitation Policy.
Neonatal Resuscitation Maternity Policy
Medical Devices Management Policy
First Aid At Work Policy
People Moving and Handling Policy
Management of the Deteriorating Patient
Key Words (to aid with searching)
Cardiopulmonary; resuscitation; CPR; defibrillation;
anaphylaxis; heart arrest; cardio respiratory services;
bariatric patients
Version Tracking
Version Date Ratified
12
23rd January
2012
13
Brief Summary of Changes





Author
Resuscitation
Manager
Clarity given to the response to non-clinical areas and
the Duty Hospital Manager role
Clarity given to the response to external buildings
Post anaphylaxis reaction actions listed
Neonatal Emergency Team/Flat Baby Team name
changed to Neonatal Crisis Team
References updated including the reference to
NHSLA removed and the National Early Warning
System and NCEPOD added
CONTENTS
Cardiopulmonary Resuscitation
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QUICK REFERENCE GUIDE ............................................................................................................. 3
1.
INTRODUCTION.......................................................................................................................... 4
2.
PURPOSE ................................................................................................................................... 4
3.
SCOPE ........................................................................................................................................ 4
4.
DEFINITIONS .............................................................................................................................. 4
5.
DUTIES AND RESPONSIBILITIES ............................................................................................. 7
6.
PROCESS ................................................................................................................................... 8
7.
TRAINING REQUIREMENTS .................................................................................................... 15
8.
REFERENCES AND ASSOCIATED DOCUMENTATION ......................................................... 15
9.
EQUALITY IMPACT STATEMENT ............................................................................................ 16
10. MONITORING COMPLIANCE ................................................................................................... 17
APPENDIX 1: Resuscitation Training Needs Analysis for staff with frequent, regular contact with
patients…………………………………………………………………………………………………………18
APPENDIX 2: Anaphylaxis algorithm and investigations ….………………………………………….....20
APPENDIX 3: Cardiac Arrest/Medical Emergency Response Teams and equipment availability for
non-clinical areas on QAH site…………………………………………..…………………………………..22
APPENDIX 4: Minimum Personnel, Skills and Knowledge Levels for Queen Alexandra Hospital
Cardiac Arrest Teams (CAT)………………………………………………………………………………...25
APPENDIX 5: Cardiac arrest record forms…………………………………………………………………28
APPENDIX 6: Electrical equipment safety during defibrillation………………………………………..…32
APPENDIX 7: Defibrillation during renal replacement therapy using vascular access …………….....33
.
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QUICK REFERENCE GUIDE
This policy must be followed in full to ensure that a high-quality and robust resuscitation service is
available for patients, staff and visitors at all times.
For quick reference the guide below is a summary of actions required. This does not negate the need
for all staff to be aware of and follow the detail of this policy.
1. All patients, staff and visitors will receive safe, early and appropriate Cardiopulmonary
Resuscitation, including early defibrillation when required
2. All staff with frequent, regular patient contact will attend annual resuscitation training relevant
to their role. This training will include, as appropriate, anaphylaxis management, identification
and response to the deteriorating patient, DNACPR and post resuscitation care;
3. All in-patient vital signs will be recorded and an early warning score will be generated as per
Management of the Deteriorating Patient policy (5). This will indicate whether escalation of
care is required and ensure the appropriately skilled healthcare professional is called. This
will aid identification and response to patients at risk from cardio-respiratory arrest;
4. All patients having an anaphylactic reaction will be managed following the current
Resuscitation Council (UK) guidance (6);
5. All cardiac arrest equipment must be checked on a daily basis and after use by a registered
healthcare practitioner to ensure continually availability in clinical areas;
6. All staff using a defibrillator will attend training on an annual basis to demonstrate practical
and theoretical competence in the safe use of a defibrillator;
7. To enable the monitoring of compliance to this policy all respiratory and cardiac arrests will be
recorded on the current PHT Cardiac Arrest Form.
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1. INTRODUCTION
This Cardiopulmonary Resuscitation (CPR) policy is based on the quality standards for
cardiopulmonary resuscitation practice and training published by the Resuscitation Council (UK)
(Nov 2013) (1). It has been developed to describe the process for managing and mitigating risks
associated with resuscitation, by also incorporating the key finding and recommendations from the
NECOPD report - Time to Intervene (2012), within Portsmouth Hospitals NHS Trust (the Trust).
The Trust must provide a resuscitation service for patients, visitors and staff on its sites. The aim
is that all health care staff who have direct patient contact must be able to provide CPR at levels
appropriate to their role and healthcare environment in which they are working. As a minimum this
is Basic Life Support (BLS). However, some staff e.g. doctors, nurses and technicians must
provide elements of Advanced Life Support (ALS), including defibrillation.
CPR is undertaken in an attempt to restore breathing (sometimes with support) and spontaneous
circulation in a patient in cardiac and/or respiratory arrest. CPR is a relatively invasive medical
therapy and it is therefore essential to identify patients for whom cardiac and/or respiratory arrest
represents a terminal event in their illness. The Trust has a Do Not Attempt Cardiopulmonary
Resuscitation (DNACPR) policy which should be read in conjunction with this policy to ensure that
CPR is only initiated for patients when it is appropriate and in their best interests.
2. PURPOSE
The purpose of this policy is to ensure that:
 prompt, safe, early and appropriate cardiopulmonary resuscitation and defibrillation occurs
within the Trust;
 the management of anaphylaxis follows the Resuscitation Council (UK) guidelines (6) and
appendix 2;
3. SCOPE
This policy applies to all staff (including voluntary workers, students, locums and agency) of
Portsmouth Hospitals NHS Trust, the MDHU (Portsmouth) and Carillion, whilst acknowledging for
staff other than those of the Trust the appropriate line management or chain of command will be
followed.
In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it
may not be possible to adhere to all aspects of this document. In such circumstances, staff should
take advice from their manager and all possible action must be taken to maintain ongoing patient
and staff safety.
4. DEFINITIONS
Adult Manual Defibrillation Pads
Adhesive external pads which are attached to the patient to enable the delivery energy for external
pacing, defibrillation or cardioversion purposes. Adult pads are used for all patients over 10kg.
Advanced Life Support (ALS)
The term ALS describes additional measures aimed at restoring ventilation and a perfusing
cardiac rhythm: this is necessary to improve the chance of long term survival.
Anaphylaxis is an acute life-threatening hypersensitivity reaction and should be considered when
there is an acute onset, life threatening airway and/or breathing and/or circulation problems;
especially if skin changes present (Appendix 2).
Automated External Defibrillators (AED)
The defibrillator itself analyses the cardiac rhythms, and advises whether a shock is indicated or
not, and selects the appropriate energy levels according to the current Resuscitation Council (UK)
Guidelines (3). AED’s allow staff such as nurses and physiotherapists to defibrillate prior to the
arrival of more expert help. AED’s can be used on paediatric patients however attenuated pads
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that reduce the energy delivered are used for children weighing less than 25kg. Where possible,
AED’s should be avoided in the under one year old age group due to potential problems with
rhythm recognition.
Basic Life Support (BLS)
The purpose of BLS is to maintain adequate oxygenation to the vital organs through maintenance
of ventilation and circulation. This is continued until the respiratory/cardiac arrest is reversed,
and/or the underlying cause treated, or the resuscitation attempt is stopped. It is therefore a
"holding measure" until defibrillation and/or advanced life support is available. Failure of the
circulation for three to four minutes (less if the victim is initially hypoxaemic) will lead to irreversible
cerebral damage. Delay, even within that time, will lessen the eventual chances of a successful
outcome. Emphasis must therefore be placed on prevention of cardiac arrest and early access to
help then rapid institution of BLS by a rescuer if required.
Basic Life Support with Airway Adjunct
Basic life support implies that no equipment is employed. When a simple airway device or
facemask is used to assist the delivery of ventilations, this is defined as "basic life support with
airway adjunct".
Cardiac Arrest
Cardiac arrest is the sudden cessation of mechanical cardiac activity, confirmed by the absence of
a detectable pulse, unresponsiveness, and apnoea or agonal, gasping respiration.
Cardiac Arrest Team (CAT)
A Cardiac Arrest Team is available on the Queen Alexandra Hospital site at all times and
comprises staff trained in ALS. There are different teams for different patient groups as identified
in Appendix 7. These teams must achieve a recommended level of training to achieve the required
skill set (Appendix 8).
Cardiac Rhythms
Cardiac rhythms associated with cardiac arrest can be divided into two groups: ventricular
fibrillation / pulseless ventricular tachycardia (VF/VT) and other rhythms (Non VF/VT). The latter
includes asystole and pulseless electrical activity (PEA). The principle difference in the
management of these two groups is the need for defibrillation in those patients with VF/VT.
Subsequent actions, including chest compressions, airway management and ventilation, venous
access, the administration of adrenaline, and the identification and correction of reversible causes,
are common to both groups.
Cardiopulmonary Resuscitation (CPR)
Cardiopulmonary Resuscitation is a combination of artificial ventilation, chest compressions, drug
therapy and defibrillation.
Cardioversion
This term will be taken to mean synchronised cardioversion i.e. the synchronised button is used to
ensure that a DC shock is not delivered on the "T" wave, which in the susceptible heart can lead
to VF or VT.
Chain of Survival
The interventions that contribute to a successful outcome after cardiac arrest can be
conceptualised as a chain. The four links of the chain comprise of: early recognition and call for
help (i.e. phone 2222), early CPR, early defibrillation and post resuscitation care
Clinical Staff
A member of trust staff whose job description includes direct patient care.
Defibrillation
Defibrillation is the definitive treatment for Ventricular Fibrillation (VF) and pulseless Ventricular
Tachycardia (VT). It involves the delivery of a DC electric shock to the myocardium. The energy
level to be administered is defined in the current ALS guidelines by the Resuscitation Council
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(UK). For defibrillation to be effective, a critical mass of the myocardium needs to be depolarised
to allow the heart’s own pacemakers to resume control.
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)
A DNACPR order indicates that in the event of a cardiac arrest, CPR will not be initiated.
DNACPR decisions are the overall responsibility of the Consultant/General Practitioner in charge
of the patient’s care. Attempts at CPR will not be commenced when it is felt that a patient would
not survive or when it is not the patient’s wishes. It is emphasised that a DNACPR decision does
not prevent other forms of treatment being provided. See current Trust DNACPR Policy for further
detail.
Early Warning Score and Escalation Protocols
For adult in-patients the early warning system and escalation protocol is incorporated into
VitalPAC. This is a tool for bedside evaluation of physiological parameters provides prompts to the
clinical staff on when and who to call for additional help. There are adapted early warning systems
and escalation protocols for Obstetric and Paediatric in-patients. Further information is in the Trust
Management of the Deteriorating Patient Policy.
Neonate
For the purpose of this policy a neonate is any infant cared for within the Maternity Unit or
Neonatal Intensive Care Unit (NICU) regardless of age. For other areas within the organisation the
neonate is a baby below 29 days of age.
Newborn Resuscitation Policy
The newborn resuscitation policy outlines the management of the newborn/neonate infant whilst in
Maternity and NICU.
Non-clinical staff
A member of the Trust staff whose job description does not include direct patient care. Some staff
in this group need to attend annual resuscitation training, if their role includes patient contact
without clinical staff immediately available, such as reception staff.
Paediatric AED defibrillation pads
Adhesive external pads used with an automated external defibrillator which itself analyses the
cardiac rhythms. The pads are attached to the patient but reduce the energy before the delivery of
current for defibrillation or cardioversion is delivered. These are used for paediatric patients under
25kg.
Paediatric Manual defibrillation pads
Adhesive external pads used for infants under 10kg.
Paediatric Resuscitation Guidelines
The paediatric resuscitation BLS guidelines are related to size and used for the management of an
infant, a baby under one year, and for a child between one year and puberty. The paediatric ALS
guidelines are weight related and therefore apply to all babies and pre-puberty children.
Patient Group Direction (PGD)
Patient Group Directions (PGDs) are documents which make it legal for medicines to be given to
groups of patients - for example in a vaccination programme - without individual prescriptions
having to be written for each patient. They can also be used to empower staff other than doctors
(for example paramedics and nurses) to legally give the medicine in question.
Respiratory Arrest
Respiratory arrest is the cessation of spontaneous breathing.
2222 is the emergency number for the Cardiac Arrest Response at Queen Alexandra Hospital
(QAH), St. Mary’s Community Hospital (SMH) and Gosport War Memorial Hospital (GWMH).
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5. DUTIES AND RESPONSIBILITIES
Resuscitation Manager and the Resuscitation Training Team
The Resuscitation Manager and the Team are responsible for ensuring that:
 Resuscitation Training delivered to Trust staff adheres to the current Resuscitation
Council (UK) guidelines and incorporates training on the current early warning system
used by the Trust for the identification of patients at risk, including the systems for
summoning help, and DNACPR decision making;
 The delivery of annual resuscitation training updates including the requirement for
attendees to be aware of the need to read and implement this policy and the DNACPR
policy;
 All ‘2222’ calls relating to medical emergencies and cardiac arrests are reviewed and
relevant data is collected Monday to Friday by a Resuscitation Officer (RO) and entered
on the database.
 All cardiac arrest data from Portsmouth Hospitals NHS Trust is submitted to the
National Cardiac Arrest Audit (NCAA) ICNARC - Intensive Care National Audit &
Research Centre
 A Resuscitation Officer will:
o Review all returned audit sections of the DNACPR form and ensure key data is
entered onto the database;
o Lead on collecting data on resuscitation
 A rolling annual audit of the Cardiac Arrest equipment is undertaken in the Trust clinical
areas located on the Queen Alexandra Hospital, St Mary’s Community Hospital,
Petersfield Community Hospital and Gosport War Memorial Hospital sites;
 There are equipment and daily check lists available for the clinical staff to ensure the
cardiac arrest equipment is in a state of readiness at all times.
The Resuscitation Link Network
The Network, which meets quarterly, consists of resuscitation link champions from each clinical
area and all the Resuscitation Officers, each of whom chair the Network on a rolling basis. The
Network is utilised to cascade information to and from the clinical areas, to support organisational
learning and feedback
Line Managers
Line Managers are responsible for:
 Ensuring the daily checks are completed on the cardiac arrest equipment to ensure it is
in a state of readiness at all times;
 Taking any unresolvable queries to the link champions or Resuscitation Manager who
will take it to the appropriate forum for resolution;
 Releasing their staff to attend Resuscitation Training, in accordance with the
requirements identified in Appendix 1, and monitoring attendance using the monthly
reports from Learning and Development.
All Clinical Staff
All staff are responsible for ensuring that they:
 Immediately alerting the appropriate response team in the event of a cardiac/obstetric or
neonatal emergency (see section 6.2.2);
 Practice within the current Resuscitation Council (UK) Guidelines and their own Codes
of Professional Conduct;
 Attend the appropriate resuscitation training annually, as in Appendix 1. This will be
monitored by the Line Managers and the Clinical Service Centre (CSC) Governance
Steering group using the monthly reports from Learning and Development;
 Participate in the daily checking of cardiac arrest equipment to make sure the
equipment is in a state of readiness at all times;
 Are familiar with the processes to follow if any cardiac arrest equipment fails or is found
to be faulty during the daily operational check or when being used.
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Patient Safety Working Group
The Committee is responsible, through the receipt of quarterly reports from the Resuscitation
Committee, there is continuous and measurable improvement in the quality of the services
provided.
The Trust Resuscitation Committee
The Committee is responsible for ensuring that:
 This procedural document is up to date, technically accurate, is in line with evidencebased best practice and has been produced following consultation with stakeholders
 The processes to enable audits of compliance and monitoring of trust standards, as
detailed in this policy, are in place and the actions identified as a result of those audits
are implemented.;
 Through the Chair, assurance on the effectiveness of this policy and the Trust’s
procedures for CPR, is provided through a quarterly report to the Patient Safety
Working Group, including any necessary recommendations to address identified
deficits;
Cardiac Arrest Teams
The Teams consist of four members: a team leader; an airway technician; a circulation technician;
and an assistant. Members of the team must respond at the earliest opportunity to any cardiac
arrest bleep, including the test call, which is tested at random each day. The members of each
team are outlined in Appendix 3.
Clinical Engineering Team
The Team is responsible for:
 Responding to reports of any faults with defibrillators and for making arrangements to
repair or replace the equipment (24 hour cover via the Queen Alexandra switchboard).
6. PROCESS
6.1 Identification of patients at risk of cardio-respiratory arrest.
There is a Trust Management of the Deteriorating Patient Policy (5) developed in response
to the key recommendations of the NICE Clinical Guideline 50. The policy describes in full
the process for managing and mitigating risks relating to all aspects of the treatment and
care of adults who are acutely ill or at risk of physical deterioration and cardio-respiratory
arrest.
6.2 Cardiac Arrest Response
6.2.1 CPR should be commenced for all patients/visitors/staff who suffer a cardiac arrest,
unless there is a valid DNACPR decision in place.
6.2.2 Queen Alexandra Hospital Site
It is the responsibility of the clinical staff to ensure that patients, visitors and staff
suffering a respiratory or cardiopulmonary arrest, receive the appropriate treatment as
described in current guidelines by the Resuscitation Council (UK) and as per the
appropriate site response.
The appropriate emergency response/team will be summoned by using the universal
number 2222. The precise location of the patient must be communicated promptly and
clearly to the switchboard operator
 Adult patients state Adult Cardiac Arrest Team
 Obstetric patients state Maternal Crisis Team and Adult Cardiac Arrest Team
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 Paediatric patients state Paediatric Cardiac Arrest Team
 Neonates state Neonatal Crisis Team
All cardiac arrest bleeps are alerted simultaneously by the Queen Alexandra Hospital
switchboard operator via a speech channel. Each member of the emergency team
that has been called must attend the specified location immediately. ALS will be
provided by the responding team. The composition and skills of the teams above are
detailed in Appendix 3 and 4.
Note: The speech channel is tested at random each day, to ensure that the system
and individual bleeps are in working order. All bleep holders must respond to this test
call.
6.2.3 St Mary’s Community Hospital and Gosport War Memorial Hospital sites.
The response on these sites is BLS, AED and Ambulance. These hospital sites have
a switchboard system so use the universal number 2222. This enables switchboard to
activate the medical emergency response bleeps and then call the ambulance service.
The member of staff should return to the victim to commence BLS.
BLS and AED response as per Resuscitation Council (UK) guidelines will be provided
by the healthcare staff present and Advanced Life Support will be provided by the
ambulance service.
All medical emergency response bleeps will be alerted simultaneously by the relevant
site switchboard operator via a speech channel. Each member of the site response
team must respond at their earliest opportunity. The speech channel will be tested at
random each day, to ensure that the system and individual bleeps are in working
order, all bleep holders must respond to this test call.
6.2.4 Petersfield Community Hospital and other Community sites such as Health
Centres
The response on these sites includes BLS, AED and Ambulance. As there is no
switchboard facilities at these sites the Trust healthcare staff present should be aware
of the site response procedures to enable the ambulance response to be summoned
promptly.
BLS and AED (if available) response as per Resuscitation Council (UK) guidelines will
be provided by the healthcare staff present and Advanced Life Support will be
provided by the ambulance service
6.2.5 Resuscitation in non-clinical areas within main buildings
The nearest member of staff to the incident must summon help as per site response.
If there is a nearby clinical area then they should be contacted to provide clinical
expertise and equipment to patients, visitors and staff. The Duty Hospital Manager will
attend the cardiac arrest team calls in non-clinical areas. Their role is to co-ordinate
the situation in conjunction with the cardiac arrest team leader, and arrange, if
appropriate, transfer of the victim to a “Place of Safety”. This is likely to require a
clinical member of staff to contact Main Porters via Ext: 6321 for an urgent transfer.
Some non-clinical areas/departments will have a designated person responsible for
first aid who should also be summoned. See the Trust’s First Aid at Work Policy for
further details.
See Appendix 6 for details of Cardiac Arrest Equipment cover for non-clinical areas.
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6.2.6 Resuscitation in areas or buildings outside of the main buildings (e.g. Oasis
Centre, QuAD Centre, Health Records Building, Victoria House, Residences,
grounds, car parks)
If the victim has collapsed in an area or building outside of the main hospital buildings
staff should dial the normal emergency number for the site using the nearest internal
telephone and switchboard will call an ambulance for transfer to a place of safety.
If access to an internal phone is not possible, for example the victim is in an isolated
place, then staff should call an ambulance directly as they would in the community
setting.
6.2.7 Staff Illness
For members of staff who have a life-threatening emergency at work the procedures
outlined above should be followed.
6.3
Documentation
6.3.1 Cardiorespiratory arrests in Queen Alexandra Hospital
All cardiorespiratory arrests in Queen Alexandra Hospital must be recorded on the
Cardiac Arrest Record Form (Appendix 5).
The inner copy of the Form must be detached and returned to the Trust Resuscitation
Department, by the member of staff who completed the form.
6.3.2 Cardiorespiratory arrests in community sites
All cardiorespiratory arrests in community sites must be recorded on the Community
Sites Audit Form (Appendix 5) and returned to the Resuscitation Department, by the
member of staff who completed the form.
6.4
6.5
Post resuscitation care.
The healthcare staff responsible for the patient’s care, such as Cardiac Arrest Team Leader
or Nurse in Charge or Duty Hospital Manager, must ensure safe continuity of care and
where necessary, safe transfer following resuscitation. This may involve one or more of the
following steps:

Referral to a specialist;

Full and complete documentation and hand-over of care;

Preparation of equipment, oxygen, drugs and monitoring systems;

Intra-hospital or inter-hospital transfer;

Liaison with the Ambulance Service;

Liaison with staff experienced in patient retrieval and transfer;

Informing relatives;

Completion of an Adverse Incident Reporting Form if indicated and in accordance with
Trust Policy (13).
Ensuring continual availability of cardiac arrest equipment
6.5.1 All cardiac arrest equipment must be maintained in a state of readiness at all times
and must be checked by a registered healthcare practitioner every day of
ward/departments clinical activity and immediately following conclusion of a cardiac
arrest event. The defibrillator must be operationally checked in accordance with the
instructions issued by the Clinical Engineering Department. Daily check lists must be
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kept within the clinical areas for the life of the defibrillator and suction machine (which
will be on average ten years) plus one year for audit purposes.
6.5.2 If any cardiac arrest equipment fails or is faulty during the daily operational check or
when being used, the ward/department based clinical staff must be familiar with the
local procedure for this scenario (i.e. the clinical staff would go to the next nearest
clinical area and arrange appropriate cover). Defibrillator faults must be reported
immediately to the Clinical Engineering Department (24hr cover via Queen Alexandra
Hospital switchboard) so arrangements can be made for repair or replacement as
soon as possible. Additional information can be found in the Trust Policy and
Protocol for Management of Medical Devices (10).
6.5.3 The cardiac arrest equipment held must be stocked in accordance with a standardised
list issued by the Resuscitation Committee (8). The current list can be found on the
Resuscitation Department intranet page.
6.5.4 Disposable items should be replenished at the earliest opportunity as indicated on the
Trust’s ALS equipment lists (8). Non-disposable items should be de-contaminated
and/or cleaned in accordance with both the manufacturers’ guidance and the Trustwide infection control guidance and re-instated to the trolley as soon as is practical.
Further information can be obtained on the Resuscitation Department intranet page.
6.5.5 On the Queen Alexandra Hospital site the Cardiac Arrest Drug boxes are replaced
from pharmacy during normal working hours and outside of this time they are
replaced from the Emergency Drug Cupboards (14). The locations of the Emergency
Drug cupboards are detailed on the Trust Pharmacy intranet page.
6.6
Manual Handling
In situations where the collapsed patient is on the floor, in a chair or in a restricted/
confined space the organisational guidelines for the movement of the patient must be
followed to minimise the risks of manual handling and related injuries to both staff and the
patient (15). Further information is also available from the Resuscitation Council (UK) who
have issued Guidance for Safer Handling During Resuscitation in healthcare settings (Nov
2009) (16).
6.7
Cross Infection
6.7.1 Whilst the risk of infection transmission from patient to rescuer during direct mouthto-mouth resuscitation is extremely rare, isolated cases have been reported. It is
therefore advisable that direct mouth-to-mouth resuscitation be avoided in the
following circumstances:

All patients who are known to have or suspected of having an infectious
disease;

All undiagnosed patients entering the Emergency Department, Outpatients or
other admission source;

Other persons where the medical history is unknown.
6.7.2 All clinical areas must have immediate access to a pocket mask, which must be
strategically located, to minimise the need for mouth-to-mouth ventilation. However,
in situations where airway protective devices are not immediately available, start
chest compression only CPR whilst awaiting an airway/ventilation device.
6.8
Anaphylaxis management
6.8.1 The management of suspected anaphylactic reactions must be conducted in
accordance with the current Resuscitation Council (UK) Guidelines for the
Management of Anaphylaxis (6). See Appendix 2 for the current treatment algorithm.
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6.8.2 All healthcare professionals administering medication will attend mandatory annual
Basic Life Support and Anaphylaxis training as a minimum standard.
6.8.3 For governance purposes non-prescribing healthcare professionals should use the
Portsmouth Combined NHS Trusts Patient Group Direction for the use of Adrenaline
in the Treatment of Anaphylaxis (17). In addition they must complete and maintain
the relevant anaphylaxis competency by attendance at annual training (18). Evidence
of competency is held on the ward/department in the individual’s personal
development records.
6.8.4 Following an anaphylactic reaction:
 Patients who have had a suspected anaphylactic reaction should be treated
and then observed for at least 6 hours in a clinical area with facilities for
treating life-threatening ABC problems.
 To aid diagnosis the post event the blood tests for Mast Cell Tryptase detailed
in Appendix 2 must be completed.
 The adverse reaction must be reported using the current Adverse Incident
Reporting mechanism and a MHRA ‘yellow card’ must be completed, see
PHT Cardiopulmonary Resuscitation Policy for more information
 The patient should be reviewed by a senior clinician and a decision made
about the need for further treatment or a longer period of observation.
6.8.5
6.9
Before discharge from hospital all patients must be:
 Reviewed by a senior clinician.
 Given clear instructions to return to hospital if symptoms return.
 Considered for anti-histamines and oral steroid therapy for up to 3 days.
 Considered for an adrenaline auto-injector (see below), or given a
replacement.
 Have a plan for follow-up, including contact with the patient’s general
practitioner.
Defibrillation
6.9.1 Defibrillators must only be operated by persons specifically trained in their use. The
training will be in accordance with the current Resuscitation Council (UK) Guidelines
(3). Staff authorised to manually defibrillate or use AED must have demonstrated
practical and theoretical competence to the Trust Resuscitation Department or have
attended a course recognised by the Trust’s Resuscitation Department such as
RC(UK) Advanced Life Support Course. For further recognised courses please call
Ext: 6110.
6.9.2 The member of staff must continue to update practical and theoretical competence
annually. However for flexibility and to minimise the impact on the clinical areas and
patients there is a permitted period of 2 months whereby staff can urgently arrange
an update should their certificate have expired.
6.9.3 If a patient who has had an emergency thoracotomy requires defibrillation then the
chest should be closed and external defibrillation should be delivered as per current
ALS guidelines.
6.9.4 For further information on electrical equipment safety during defibrillation see
Appendix 7.
6.9.5 For further for information on defibrillation during haemodialysis see Appendix 8.
Cardiopulmonary Resuscitation
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6.10
Procurement
For all resuscitation equipment purchasing the Medical Devices Management policy must
be followed (10). All resuscitation equipment purchased must be agreed by the
Resuscitation Manager prior to ordering.
6.11
Cardiopulmonary Resuscitation for Bariatric Patients
Standard Resuscitation Council (UK) Basic Life Support and Advanced Life Support
guidelines should be followed with additional consideration given to the following issues:
Airway and Breathing
Potential Problems

Likely to be more difficult to manage airway

Increased risk of regurgitation

May be more difficult to achieve good seal with pocket mask/Bag Valve Mask
Actions

Two person technique when using Bag Valve Mask device

Early use of airway adjuncts e.g. Oropharyngeal airway

Consider early intubation
Circulation
Potential Problems

Intravenous access likely to be more difficult to achieve

Intra-osseous may also be more difficult to achieve
Actions

If unable to achieve access, consider performing cut-down
Chest compressions
Potential Problems
 More difficult for chest compression provider to achieve correct hand/arm
position (shoulders directly above hands)

More difficult to compress adequate depth (5-6 cms)
Actions
 Position bed height to facilitate effective chest compressions. This is likely to be
with the bed at or near it’s lowest position

Compressions provider to use foot stool if available
 Consider the height of the person performing chest compressions and if a taller
member of staff is available changing the compression person should be
considered as the taller person may find it easier to achieve adequate
compressions
Defibrillation
Potential Problem
 May be more difficult to place pads in correct position
 The patients body mass may increase transthoracic impedance
Actions
 Use standard defibrillator pad position. Avoid breast tissue if possible.
 Use Standard defibrillator energy, 150 Joules, escalating to 200 Joules after
first shock
Cardiopulmonary Resuscitation
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6.12
Cardiopulmonary Resuscitation for patients with an Implantable Cardioverter
Defibrillator (ICD)
6.12.1 Deactivation of an ICD with a magnet is normally indicated when the ICD is
providing inappropriate shock therapy or the patient is undergoing emergency
surgery out of hours requiring diathermy. In these situations the decision to
deactivate the ICD should be advised by appropriately trained SpR or Consultant
with Advanced Life Support training. If an ICD has been deactivated the patient
should be closely monitored for treatable arrhythmias and an external defibrillator
should be attached to patient. A member of staff trained in external defibrillation
should remain in attendance.
6.12.2 In event of Cardiac Arrest the effectiveness of ICD should be monitored. If the ICD
provides an appropriate shock, that is not successful in correcting VT/VF, ALS
should not be delayed. A magnet can be applied during CPR (19) and should
remain in situ. Special attention must be given to the person delivering chest
compressions following a case report (20) where electrical injury to the rescuers
hand was sustained. If any risk to the rescuers is suspected then the ICD should
be deactivated with a magnet immediately and standard ALS protocols followed.
External pads should be placed 8cm away from the device site preferably use
antero- posterior position. The Cardiology SpR or Consultant should be contacted,
as soon as possible, for further advice.
6.12.3 The magnets are stored on the cardiac arrest trolleys and should be placed over
the ICD using adhesive tape. The ICD site is indicated by scar; usually left infra
clavicular or rarely right infra claviclular region. Very rarely ICD may be in
abdomen or groin.
6.12.4 Post CPR if there is return of spontaneous circulation leave the magnet in situ until
ICD is reprogrammed by a Cardiac Physiologist. If the patient dies then advise
mortuary technicians to remove magnet and inform Cardiac Physiologists of
patient’s location.
6.12.4 Some ICD devices cannot be deactivated with a magnet. This is rare and if it
occurs the patient should be made comfortable with sedation. If it is necessary to
identify the device manufacturer the patients are advised to carry information
regarding their device at all times.
6.13
Urgent Blood Gas Analysis in Cardiac Arrest And Peri-Arrest Situations on the QAH
site
 For urgent arterial blood gas (ABG) analysis (including potassium) at a cardiac arrest
or peri-arrest situation in the East Ward Block (Old Hospital) the blood gas
sample can be taken to the Emergency Department for testing.
 For urgent blood gas analysis (including potassium) at a cardiac arrest or peri-arrest
situation in the South Ward Block (New Hospital) the blood gas sample can be
taken to the Department of Critical Care (E5) for testing.
 All non-urgent ABG's should be taken to the Pathology Laboratory (Path Lab)
having ensured the samples and forms are fully and correctly labelled at the bedside.
The blood gas machine in the Path Lab cannot provide a potassium result and
therefore a serum potassium sample should also be taken if required.
 To save time in emergency situations, there are blank biochemistry/haematology
request forms on all the cardiac arrest trolleys.
 The blood gas syringes compatible with all analyzing machines is the Radiometer
PICO70 syringes.
Cardiopulmonary Resuscitation
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Page 14 of 33
 All non-urgent blood gases should continue to be sent to the Pathology Laboratory
in the usual way.
7. TRAINING REQUIREMENTS
7.1
The strategy for resuscitation training embodies the statements and guidelines published
by the Resuscitation Council (UK) and the European Resuscitation Council, incorporating
the most recent updates to these guidelines. This explicitly incorporates current Do Not
Attempt Cardiopulmonary Resuscitation (DNACPR) policy, the identification of patients at
risk from cardiac arrest and a strategic approach to implement preventative measures such
as Early Warning Systems/ Patient at Risk Systems.
The Trust will provide sufficient and appropriate resuscitation training for all clinical staff to
attend annually. Profession specific resuscitation training will be directed by their
respective functional role and the guidelines and directives issued by their professional
bodies (e.g. The Royal College of Anaesthetists).
All clinical staff are trained in the identification of the deteriorating and critically ill patients
and the use of physiological observation charts to enhance decision making and care
escalation. This is included in annual resuscitation training updates to a level relevant to
the staff role.
The profession specific guidelines for resuscitation training are detailed in the Training
Needs Analysis (Appendix 1). The uptake of training monitored monthly through the
reports from Learning and Development Department to all Clinical Service Centres
(CSC’s).
Clinical Staff
All doctors, nurses, midwives and Allied Health Professionals must be trained annually in
cardiopulmonary resuscitation to a level appropriate to their clinical roles and
responsibilities. The level of that training is determined by their respective professional
bodies (e.g. General Medical Council) and/or the duties that those staff would be expected
to undertake when in attendance at a cardiac arrest/medical/obstetric/neonatal
emergency. This is detailed in the Training Needs Analysis (Appendix 1).
Non-Clinical Staff
All hospital staff with frequent, regular unsupervised (by clinical staff) contact with patients
should be trained in basic life support (BLS).
8. REFERENCES AND ASSOCIATED DOCUMENTATION
1. Resuscitation Council (UK) (2013) quality standards for cardiopulmonary resuscitation
2.
3.
4.
5.
6.
7.
practice and training. Resuscitation Council (UK) - Quality standards for CPR
National Confidential Enquiry into patient Outcome and Death – Time to Intervene (2012)
NCEPOD - CAP: Time to Intervene? Report (2012)
Resuscitation Guidelines (UK) 2010. http://www.resus.org.uk/pages/guide.htm
PHT Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy. Located on the
intranet under clinical policies. http://pht/PoliciesGuidelines/ClinicalPolicies/default.aspx
PHT Management of the Deteriorating Patient Policy. Located on the intranet under clinical
policies. http://pht/PoliciesGuidelines/ClinicalPolicies/default.aspx
Resuscitation Council (UK) (2008) Emergency treatment of anaphylactic reactions.
Guidelines for healthcare providers. Resuscitation Council (UK): London
http://www.resus.org.uk/pages/mediMain.htm
PHT Neonatal Resuscitation Maternity Policy. Located on the intranet. Departments –
Maternity – Maternity Services Guidelines Neonatal Resuscitation Maternity Services Policy
Cardiopulmonary Resuscitation
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Page 15 of 33
8. Current PHT Resuscitation BLS & ALS equipment Recommendations and daily checklists
are located on PHT Resuscitation intranet site. Departments – Resuscitation. Resuscitation
Equipment Lists and Forms
9. Procedural Documents Development And Management Policy. Located on the intranet
under management policies. http://pht/PoliciesGuidelines/ManagementPolicies/default.aspx
10. PHT Medical Devices Management Policy. Located on the intranet under management
policies. http://pht/PoliciesGuidelines/ManagementPolicies/default.aspx
11. NICE Clinical Guideline 50. Acutely ill patients in hospital. Recognition of and response to
acute illness in adults in hospital. July 2007. http://guidance.nice.org.uk/CG50
12. PHT First Aid at Work Policy. Located on the intranet under health and safety policies.
http://pht/PoliciesGuidelines/HealthandSafetyPolicies/default.aspx?PageView=Shared
13. PHT Adverse Incident and Near Misses Management policy. Located on the intranet under
management policies. http://pht/PoliciesGuidelines/ManagementPolicies/default.aspx
14. Emergency Drug Cupboard List is located on PHT intranet – Departments – Pharmacy - Out
of hours. http://pharmweb/Closed/emergencydrugcupboards.asp
15. PHT People Moving and Handling policy. Located on the intranet under clinical policies.
http://pht/PoliciesGuidelines/ClinicalPolicies/default.aspx
16. Resuscitation Council (UK) (2009) Guidance for Safer Handling during Resuscitation in
healthcare settings. http://www.resus.org.uk/pages/mediMain.htm
17. Portsmouth Hospitals Trust. Patient Group Directions for Adrenaline (Epinephrine) Injection
BP 1:1000 PGD Ref No: RSS 003. Current version is located on the intranet – Departments
– Pharmacy – PGD’s http://pharmweb/FMG/PGD/Database/
18. PHT Competency Statements on Adult and Paediatric Anaphylaxis. PHT intranet. Learning
and Development Zone, Nursing and Midwifery. Generic Nursing and Midwifery
Competency Framework
19. Nolan JP et al. Part 1: Executive summary: 2010 International Consensus on
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With
Treatment Recommendations. Resuscitation 2010;81:e1-e25.
20. Stockwell B., Bellis G., Morton G., Chung K., Merton W. L., Andrews N. P., Smith G. B.
Case report. Electrical injury during “hands on” defibrillation—A potential risk of internal
cardioverter defibrillators? Resuscitation 2009;80;832-4
9.
EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably
practicable, the way we provide services to the public and the way we treat our staff reflects
their individual needs and does not discriminate against individuals or groups on any grounds.
This policy has been assessed accordingly
Cardiopulmonary Resuscitation
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Page 16 of 33
10. MONITORING COMPLIANCE
The document will be monitored to ensure it is effective and to assurance compliance. As a minimum, the following elements will be monitored.
Minimum requirement to
be monitored
Lead
Tool
Frequency of
Reporting of
Compliance
100% of Cardiac Arrest are
audited using the Cardiac
Arrest Record Form and
entered in to the National
Cardiac Arrest Audit (NCAA)
Resuscitation
Manager
PHT Cardiac Arrest
Record Form based on
the Utstein Template
(Appendix 5)
Annually
Continual availability of
resuscitation equipment:
equipment will be available at
all times
Resuscitation
Manager
Current Resuscitation
Equipment Standards
(8)
Annually
85% of staff will attend Basic
Life Support training annually
as set out in training needs
analysis
Learning and
Development
Business
Manager
Audit of Electronic Staff
Record
Annually
Cardiopulmonary Resuscitation
Issue 13 25th April 2014
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Reporting arrangements
Policy & NCAA Audit Report

Resuscitation Committee
quarterly

Patient Safety Working
Group quarterly
Policy Audit Report to

Page 17 of 33
Resuscitation Manager
Resuscitation Manager
Resuscitation Committee
Policy Audit Report

Lead(s) for acting on
recommendations
Resuscitation Committee
CSC Heads of Nursing /
Chiefs of Service
Resuscitation Training Needs Analysis for staff with frequent, regular contact with patients
Appendix 1
Minimum standard for all clinical staff and non-clinical staff with frequent, regular contact with patients




As a minimum standard all clinical staff with direct Adult patient contact must attend Adult Basic Life Support (BLS) annually.
As a minimum standard all clinical staff with direct Paediatric patient contact must attend Paediatric Basic Life Support (BLS) annually.
As a minimum standard all clinical staff with direct Newborn patient contact must attend Newborn Life Support annually.
As a minimum standard all clinical staff with direct Maternal patient contact must attend Maternal Basic Life Support (BLS) annually.
Annual Resuscitation Training for Registered Nursing/Midwifery/AHP’s with Direct Patient Contact
PHT
Adult
BLS
PHT
Paed
BLS
PHT
CSSD
PHT
Adult
BLS &
AED
Anaphylaxis
Training if
administering
medicines
RC (UK)
ALS
Provider
Course
Registered Staff in
M
D
M
D
Adult Critical Care
Every 2
Areas
years
Registered Staff in
M
D
M
Acute Adult Ward
Every 2
Areas
years
Registered Staff in
M
M
M
Community
Hospitals
Registered Staff in
M
M
Adult non-ward
clinical areas
Registered Staff in
M
M
M
Paediatric Areas
Registered Staff in
M
M
Newborn Areas
Registered staff in
M
M
Maternity Areas
BLS = Basic Life Support
CSSD = Critical Skills Study Day
ILS = Immediate Life Support
EPLS = European Paediatric Life Support
NICU = Neonatal Intensive Care Unit M = Mandatory on an annual basis
Cardiopulmonary Resuscitation
Issue 13 25th April 2014
(Review date: 24th April 2017 unless requirements change)
RC (UK)
ILS
Course
EPLS/
APLS
Course
RC (UK)
pILS
Course
RC (UK)
Newborn
Life
Support
Course
PHT NICU
Resuscitation
Training
Programme
PHT Maternal
BLS and
anaphylaxis
PHT
Newborn
Life
Support
Update
D
D
D
D
D
M
M
M
AED = Automated External Defibrillation
APLS = Advanced Paediatric Life Support
D = Desirable
Page 18 of 33
M
ALS = Advanced Life Support
pILS= Paediatric Immediate Life Support
Blank = Not Applicable
Appendix 1 cont.
Annual Resuscitation Training for Medical Staff with Direct Patient Contact
Adult
BLS
Paed
BLS
PHT
Adult
ALS
Anaphylaxis
Training if
administering
medicines
RC (UK)
ALS
Provider
Course
M
M
FY1(D)
M
D
D
D
M
M
PHT Adult
Manual/AED
Defibrillation
EPLS/
APLS
Course
Medical Staff On Adult
Cardiac Arrest Team
All Other Medical Staff with
direct adult patient contact
Anaesthetists
M
M
M
M
Medical Staff On Paediatric
Cardiac Arrest Team
All Other Medical Staff with
direct paed patient contact
Medical Staff On Neonatal
Emergency Response Team
All Other Medical Staff with
direct Neonatal patient
contact
Medical Staff On Maternal
Emergency Response Team
All Other Medical Staff with
direct Maternal patient
contact
M
M
M
M
M
M
M
D
M
RC (UK)
pILS
Course
PHT Paed
Manual
Defibrillation and
Anaphylaxis
RC (UK)
Newborn Life
Support
Course
NICU
Resuscitation
Training
Programme
Maternal
BLS
M
D
D
D
D
D
D
D
M
M
M
M
M
M
M
M
M
M
D
M
M = Mandatory on an annual basis
M
D = Desirable
Cardiopulmonary Resuscitation
Issue 13 25th April 2014
(Review date: 24th April 2017 unless requirements change)
Blank = Not Applicable
Page 19 of 33
M
Appendix 2
Resuscitation Council (UK) Anaphylaxis Treatment Algorithm
Cardiopulmonary Resuscitation
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Page 20 of 33
Appendix 2 cont
Investigations post anaphylactic/severe allergic reaction
When a patient experiences an adverse event that is thought to be a possible anaphylactic or
anaphylactoid reaction, ensure that the following basic samples are obtained:
An EDTA plasma (purple top) or serum sample (red or yellow top) for tryptase estimation
(one bottle will suffice)
Sample
As soon as possible after, or within one hour of, onset of the reaction.
1
Sample
2
3 hours post-reaction
Sample
3
24 hours post-reaction (required to act as a baseline to exclude
mastocytosis).
Sample transport
These samples can be transported at room temperature to the laboratory where they will be
stored until the series is received.
Interpretation of results
Peak
tryptase
level
Systolic BP
(mmHg)
>50ug/L
Unrecordable
Type I Hypersensitivity (drug history required
for allergen specific IgE studies).
2050ug/L
20-80
Non-immune anaphylactoid reaction either
(i) direct release by pharmacologically active
drugs or (ii) complement activation.
2-20ug/L
100-120
Probable bronchospasm
NB: It is very important to tell the lab when samples were taken in relation to the precipitating
event. Sometimes, they will add a total IgG, which should not change acutely. Any changes in
IgG over a short period of time, may indicate that a peak tryptase might be underestimated
following any acute fluid administration.
There will be occasions when this protocol is unworkable and a single blood sample taken
post mortem for example, may still be of value in the investigation of underlying causative
pathology.
Cardiopulmonary Resuscitation
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Page 21 of 33
Appendix 3
Cardiac Arrest and Emergency Response Teams
Table 1. ADULT Cardiac Arrest Team at Queen Alexandra Hospital
Team
Medical SpR/ST3 and above
Resuscitation Committee recommended
minimum training standard
ALS & PHT ALS
Medical SHO/FY2/ST1 & 2
ALS & PHT ALS
Medical FY1/FY2
PHT ALS/ILS (ALS desirable)
Doctor from DCCQ
PHT ALS
Department Nurse / AHP
BLS/CSSD/ILS
Specialty Nurse Bleep Holder
CSSD/ILS
Emergency
Number
2222
State Cardiac
Arrest Team
and location
Table 2. PAEDIATRIC Cardiac Arrest Team at Queen Alexandra Hospital
Team
Paediatric SpR/ST3 and above
Resuscitation Committee recommended
minimum training standard
APLS/EPLS
Paediatric SHO/ ST1&2
pILS/EPLS
SpR from DCCQ
EPLS/APLS
Paediatric Nurse Bleep Holder
pILS
Department Nurse / PAM
Adult & Paed BLS/CSSD/ILS
Emergency
Number
2222
State Paediatric
Cardiac Arrest
Team and
location
Table 3: NEONATAL Crisis Team at Queen Alexandra Hospital
Team
Resuscitation Committee recommended
minimum training standard
Neonatal Consultant
NLS
Neonatal SpR/ST3 and above
NLS
Neonatal SHO/FY2/ST1&2
NLS
NLS or NICU Resuscitation Training
programme
NLS or NICU Resuscitation Training
programme & Adult BLS
Department Nurse
Nurse in Charge of each Shift
Cardiopulmonary Resuscitation
Issue 13 25th April 2014
th
(Review date: 24 April 2017 unless requirements change)
Emergency
Number
2222
State Neonatal
Crisis Team
Page 22 of 33
Table 4: Response to Maternal Cardiac Arrests at Queen Alexandra Hospital
Team
Resuscitation Committee recommended
minimum training standard
Emergency
Number
Medical SpR/ST3 and above
ALS & PHT ALS
Medical SHO/FY2/ST1 & 2
ALS & PHT ALS
Medical FY1
PHT ALS/ILS (ALS desirable)
2222
State Maternal
Crisis Team
and Cardiac
Arrest Team
and location
Doctor from DCCQ
PHT ALS
Adult Cardiac Arrest Team
Maternity Crisis Team
Department Midwife/AHP
Maternal BLS
Maternity Bleep Holder
Maternal BLS
Maternity Anaesthetist
ALS & PHT ALS
Gynaecology SpR
BLS & Defib
Obstetric SpR
BLS & Defib
Anaesthetic ODP
BLS
If requested the Neonatal Crisis
Team
Neonatal Consultant
NLS
Neonatal SpR/ST3 and above
NLS
Neonatal SHO/FY2/ST1&2
NLS
ALS = Resuscitation Council (UK) Advanced Life Support Course Provider
PHT ALS= PHT Advanced Life Support for the Cardiac Arrest Team
CSSD= PHT Critical Skills Study Day
ILS= Resuscitation Council (UK) Immediate Life Support Course
APLS = Advanced Paediatric Life Support Course Provider
EPLS= Resuscitation Council (UK) European Paediatric Life Support Course Provider
pILS = Resuscitation Council (UK) Paediatric Immediate Life Support Course
NLS = Resuscitation Council (UK) Newborn Life Support Course
NICU = PHT Neonatal Intensive Care Unit
Table 5: Emergency Response in PHT Community sites
Team
Resuscitation Committee recommended minimum
training standard
Emergency
Number
Clinical areas
BLS & AED
Site specific
Non-clinical areas
BLS
Site specific
Cardiopulmonary Resuscitation
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Page 23 of 33
Table 6: Availability of Cardiac Arrest equipment to non-clinical areas on the Queen Alexandra
Hospital Site.
Equipment Provided By:
For A, B & C Level corridors in the East
Ward Block (‘Old Hospital’) the
Emergency Department (ED) staff will
respond with cardiac arrest equipment
For D, E, F & G Level corridors in the
East Ward Block (‘Old Hospital’) the
nearest clinical area will provide the
equipment
For A, B, C, D, E, F and G Level
corridors in the South Ward Block (‘New
Hospital’) the nearest clinical area will
provide the equipment
Main Entrance, Retail Shop and Coffee
Shop, A Level
North Entrance, C Level
Education Centre, E Level
Place of Safety
Emergency Department (ED)
The nearest clinical area. The clinical staff and cardiac
arrest team would then arrange the continuing care and
carry out safe transfer if required.
The nearest clinical area. The clinical staff and cardiac
arrest team would then arrange the continuing care and
carry out safe transfer if required.
Adult BLS equipment including an AED & oxygen have
been placed behind Main Reception. A Cardiac Arrest
trolley can be obtained from Paediatric Outpatient
Department. The cardiac arrest team would then arrange
the continuing care and carry out safe transfer if required.
Adult BLS equipment including an AED & oxygen are in
Medical OPD. A Cardiac Arrest trolley can be obtained
from Orthopaedic Outpatients. The cardiac arrest team
would then arrange the continuing care and carry out
safe transfer if required.
Adult BLS equipment including an AED is held at the
Education Centre reception. A Cardiac Arrest trolley can
be obtained from E8 Ward. The cardiac arrest team
would then arrange the continuing care and carry out
safe transfer if required.
Cardiopulmonary Resuscitation
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Page 24 of 33
Appendix 4
Minimum Personnel, Skills and Knowledge Levels for Queen Alexandra Hospital
Cardiac Arrest Teams (CAT)
The CAT should consist of 4 members – a team leader, airway technician, circulation
technician and one assistant (1).
Team Leader: must
• Possess a current Resuscitation Council (UK) Advanced Life Support course certificate
• Be able to recognise cardiac arrest
• Be able to provide basic life support
• Possess a thorough understanding of the current RC (UK) guidelines for the treatment of
cardiac arrest
• Possess basic and advanced airway management skills to include use of:
o Use of simple airway opening manoeuvres
o Use of oral and nasopharyngeal airway adjuncts
o Use of laryngeal mask airway
o Tracheal intubation (preferred)
o Suction of the upper and lower airway
• Possess following skills relating to breathing:
o Use of pocket mask
o Use of bag /valve / mask devices (manual resuscitators)
o Use of oxygen therapy in emergency care
• Possess following skills relating to the circulation:
o Peripheral intravenous (IV) cannulation
o Central vein cannulation (preferred)
o Defibrillation and synchronised cardioversion
• Possess an understanding of current drug therapy for cardiac arrest
• Possess an understanding of current treatments for peri-arrest arrhythmias
• Be able to organise and co-ordinate the efforts of the cardiac arrest team
• Understand the ethics of resuscitation, including “Do not attempt cardiopulmonary
resuscitation” and “treatment limitation” decisions
• Know and understand current Portsmouth Hospitals Trust policies relating to resuscitation:
o Cardiopulmonary Resuscitation policy
o Do not attempt cardiopulmonary resuscitation policy
• Must possess good communication skills permitting the transfer of information to staff, the
relatives of cardiac arrest victims and, where appropriate, the victims themselves.
• Must complete a Cardiac Arrest Record Form for each cardiac arrest event
• Must lead the organisation of the following
o Post arrest investigations
o Post arrest transfer to coronary care unit and critical care
o Inter hospital transfer
Team member (Airway & Breathing technician)
• Must be able to recognise cardiac arrest
• Must be able to provide basic life support
• Must possess an understanding of the current RC (UK) guidelines for the treatment of
cardiac arrest
• Must possess basic and advanced airway management skills to include use of:
o Simple airway opening manoeuvres
o Oral and nasopharyngeal airway adjuncts
o Laryngeal mask airway
o Tracheal intubation, including the use of intravenous sedative and paralysing drugs
o Suction of the upper and lower airway
• Must possess following skills relating to breathing:
o Use of pocket mask
o Use of bag /valve / mask devices (manual resuscitators)
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•
•
•
•
•
o Use of oxygen therapy in emergency care
Must understand the ethics of resuscitation, including “Do not attempt cardiopulmonary
resuscitation” and “treatment limitation” decisions
Must know and understand current Portsmouth Hospitals Trust policies relating to
resuscitation:
o Cardiopulmonary Resuscitation policy
o Do not attempt cardiopulmonary resuscitation policy
Must possess good communication skills permitting the transfer of information to staff, the
relatives of cardiac arrest victims and, where appropriate, the victims themselves.
Must participate in the completion a Cardiac Arrest Record Form for each cardiac arrest
event
Must participate in the organisation of the following
o Post arrest investigations
o Post arrest transfer to coronary care unit and critical care
o Inter hospital transfer
Team member (Circulation technician)
• Must be able to recognise cardiac arrest
• Must be able to provide basic life support
• Must possess an understanding of the current RC (UK) guidelines for the treatment of
cardiac arrest
• Must possess basic airway management skills to include use of:
o Use of simple airway opening manoeuvres
o Use of oral and nasopharyngeal airway adjuncts
o Suction of the upper and lower airway
• Must possess following skills relating to breathing:
o Use of pocket mask
o Use of bag /valve / mask devices (manual resuscitators)
o Use of oxygen therapy in emergency care
• Must possess following skills relating to the circulation:
o Peripheral intravenous (IV) cannulation
o Central vein cannulation (preferred)
o Defibrillation and synchronised cardioversion
• Must understand the ethics of resuscitation, including “Do not attempt cardiopulmonary
resuscitation” and “treatment limitation” decisions
• Must know and understand current Portsmouth Hospitals Trust policies relating to
resuscitation:
o Cardiopulmonary Resuscitation policy
o Do not attempt cardiopulmonary resuscitation policy
• Must possess good communication skills permitting the transfer of information to staff, the
relatives of cardiac arrest victims and, where appropriate, the victims themselves.
• Must participate in the completion a Cardiac Arrest Record Form for each cardiac arrest
event
• Must participate in the organisation of the following
o Post arrest investigations
o Post arrest transfer to coronary care unit and critical care
o Inter hospital transfer
1 other Team Member (assistant)
• Must be able to recognise cardiac arrest
• Must be able to provide basic life support
• Must possess an understanding of the current RC (UK) guidelines for the treatment of
cardiac arrest
• Must possess basic and advanced airway management skills to include use of:
o Use of simple airway opening manoeuvres
o Use of oral and nasopharyngeal airway adjuncts
o Suction of the upper and lower airway
• Must possess ability to assist airway technician (see above)
• Must possess following skills relating to breathing:
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•
•
•
•
•
•
o Use of pocket mask
o Use of bag /valve / mask devices (manual resuscitators)
o Use of oxygen therapy in emergency care
Must possess ability to assist circulation technician (see above)
Must possess an understanding of current drug therapy for cardiac arrest
Must understand the ethics of resuscitation, including “Do not attempt cardiopulmonary
resuscitation” and “treatment limitation” decisions
Must know and understand current Portsmouth Hospitals Trust policies relating to
resuscitation:
o Cardiopulmonary Resuscitation policy
o Do not attempt cardiopulmonary resuscitation policy
Must possess good communication skills permitting the transfer of information to staff, the
relatives of cardiac arrest victims and, where appropriate, the victims themselves.
Must participate in the completion of a Cardiac Arrest Record Form for each cardiac arrest
event
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Appendix 5
Queen Alexandra Site Cardiac Arrest Record Form
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Appendix 5 cont
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Appendix 5 cont
Community Sites Cardiac Arrest Record Form
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Appendix 5 cont
Community Sites Cardiac Arrest Record Form cont
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Appendix 6
Electrical equipment safety during defibrillation
Electrical equipment safety during defibrillation is important for its effectiveness, the rescuers
safety and to avoid potential damage to machinery.
Electrical current predominantly takes the path of least resistance. During defibrillation the
intended destination of the current is from one pad, through the thorax and the myocardium to
the other pad. If another route is available, i.e. there is equipment attached to the patient, the
current may follow that route. In addition, the intended current pathway can be disturbed by the
presence of other devices connected to the patient.
If aberrant pathways are taken this may lead to insufficient depolarisation of the myocardium
and as a consequence defibrillation may not be successful.
It is recommended that all equipment (For example ECG machines, IV pumps, haemodialysis
machines etc) is disconnected from the patient receiving defibrillation, but this must not delay
the shock being given.
Medical equipment that has some degree of protection from defibrillation is marked with either
of the bottom two symbols however it is still recommended that this equipment be detached for
the reasons identified above.
If medical equipment has been attached to the patient during defibrillation and you are
concerned about it’s function, contact the Clinical Engineering Department for advice.
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Appendix 7
Defibrillation during renal replacement therapy using vascular access
This guidance outlines the specialty specific actions to be taken by Health Care Professionals,
should a patient have a cardiopulmonary arrest during haemodialysis (RRT) or any other renal
replacement therapy using vascular access (RRT).
This should be used in conjunction with the PHT Cardiopulmonary Resuscitation Policy (1), the
Wessex Renal Transplant Service (WRTS) Access management for Haemodialysis (packs 1
and 2) (2) and DCCQ Dialysis Catheter Care Guideline (3)


RRT therapy and defibrillation treatment plan
Immediately stop the fluid loss on the RRT machine and disconnect patient (2&3).
Defibrillation must not be delayed by attempting to return the blood held in the extra corporeal
circuit


If the patient does not require defibrillation:
Immediately stop the fluid loss on the RRT machine.
Discontinue the RRT as soon as possible (2&3)
Rationale
1. Disconnection from RRT machine removes risk of aberrant current pathways & associated
risks to staff, patient and machinery.
2. Blood held in the extra corporeal circuit can be returned back to the patient (2&3).This
process must not delay defibrillation.
3. If blood is not returned, the patient may be affected by hypovolaemia. However this can be
managed with fluid replacement therapy during the cardiac arrest.





Care of Vascular access
During the cardiac arrest maintain vascular access patency (2&3).
Leave one lumen of the central venous catheter free for immediate use or leave a fistula
needle in situ if no other iv access can be obtained.
Ensure the lumen to be used is flushed with normal saline, clamped, and the end closed
between uses.
The lumen of the central venous catheter that is not used needs to be flushed and locked as
per the Renal Standard Operating Procedure for the Medical Device Duralock – c (Trisodium
citrate) Renal PGD’s .
Ensure the fistula needle to be used is flushed and kept patent as per the Renal Patient
Group Direction for Sodium Chloride Injection B 0.9% for flushing Renal PGD’s , then
clamped and closed with a cap.
Community Haemodialysis (HD)
 If the fistula needle is left in situ or the HD line lumen is being used as access, this must be
handed over to the paramedic staff.
 A care sheet should be sent to the hospital to inform the staff looking after the patient.

Continuing Care
Continue Care as per Portsmouth Hospitals NHS Trust Cardiopulmonary Resuscitation Policy
(including Anaphylaxis and Defibrillation) (1).
References
1. Current PHT Cardiopulmonary Resuscitation
2. Wessex Renal Transplant Service (WRTS) Access management for Haemodialysis (packs 1
and 2). Authors Sarah Kattenhorn & Siobhan Gladding (contact PHT Renal Unit).
3. Current PHT DCCQ Dialysis Catheter Care Guideline DCCQ Dialysis Catheter Care
Guideline.
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