Developing key performance indicators for adult critical care transfer services: Scoping review and Delphi technique.

In 2021 NHS England commissioned regional Adult Critical Care Transfer Services. These services will replace a historically predominant ad hoc approach to adult critical care transfers nationally. It is anticipated that these new formal services will provide a system of robust regional & national governance previously acknowledged to be deficient. As part of this process, it is important that an agreed set of transfer service quality indicators are developed to drive equitable improvement in patient care. We used a Delphi technique to develop a set of key performance indicators through consensus for a recently established London critical care transfer service. We believe this may be the first-time key performance indicators have been developed for adult critical care transfer services using a consensus method. We hope services will consider tracking similar measures to enable benchmarking and drive improvements in patient care.

Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018.

Extracorporeal CPR is a second line treatment for refractory cardiac arrest, as written in the latest International Guidelines. Optimal timing, patient selection, location and method of implementation vary across the world. The objective here is to present an international consensus on the pillars of an ECPR program. The major aspect the group agrees on in that ECPR should be implemented within 60 minutes of collapse. With this in mind, the program should be built according to local resources knowing that the optimal team will require pre-established specific roles with personnel dedicated to resuscitation and others to ECPR.

Traumatic cardiac arrest: a unique approach.

Resuscitation of patients who sustain a cardiac arrest as a result of trauma (traumatic cardiac arrest) has previously been described as 'futile'. Several published series have since contradicted this claim and reported survival-to-discharge data ranging from 0 to 35%. International resuscitation guidelines (European Resuscitation Council and American Heart Association) promote a consistent approach to cardiopulmonary resuscitation on the basis of up-to-date evidence and consensus opinions. This minimizes de-novo decision-making under high-stress situations, promotes a rational approach and reduces the burden on an individual clinician. This narrative review sets out to highlight the differences in aetiology of traumatic cardiac arrest as compared with medical cardiac arrest and the consequent priorities in resuscitation.

Identification and management of perioperative cardiovascular risk.

Approximately 25 000 patients die each year in the UK following 1.3 million surgical procedures (Pearse et al, 2006). More than 80% of these perioperative deaths occur in patients who are at significantly high risk for surgery (12.5%) (Pearse et al, 2006). This population tends to be older, have multiple co-morbidities and have undergone major surgery. Notably, 50% were never admitted to a general intensive care unit postoperatively (Campling et al, 1993). Approximately 75% of patients who suffer perioperative death have cardiovascular disease, so it is important to try and identify these patients preoperatively (Mangano, 1990; National Confidential Enquiry into Perioperative Deaths, 2002).