Are acute brain injury rehabilitation guidelines applied to people with brain injury after cardiac arrest?

Hill-Cottingham, C. and Nikoletou, D. (2016) Are acute brain injury rehabilitation guidelines applied to people with brain injury after cardiac arrest? In: 4th European Congress of the European Region of the World Confederation of Physical Therapy (ER-WCPT); 11-12 Nov 2016, Liverpool, U.K.. (Unpublished)


Relevance: The number of people surviving cardiac arrest is increasing. Associated with this, the number of people surviving with brain injury after cardiac arrest is also increasing. The long-term consequences have been likened to the long-term consequences of other causes of brain injury; which impact on quality of life for the individual and their family several years after the event. Multi-disciplinary rehabilitation is advocated for this patient group, which includes both cardiac and neurological rehabilitation. Brain injury rehabilitation guidelines exclusive to the cardiac arrest population are as yet outstanding, and it is unknown whether existing guidelines for adults with acquired brain injury of any cause, are being routinely applied. Purpose: This survey aimed to explore the current provision of acute NHS rehabilitation for adults with brain injury after cardiac arrest. The main objective was to investigate the extent to which current services met key recommendations from published literature and clinical guidelines, for brain injury rehabilitation. A secondary objective was to determine if there was a difference in adherence to these recommendations between hospital trusts with and without ´heart attack centres´; as increasing numbers of people are being treated in such centres after cardiac arrest. Methods/Analysis: A cross-sectional survey design was chosen, to provide quantitative data. A postal questionnaire was chosen as it would have the advantage of a known denominator population. A questionnaire was sent to each of the 144 acute NHS hospital Trusts in England. One physiotherapist from each trust was invited to respond. Individual guidelines were considered met if they were reported as being met ´always´ or ´almost always´ by respondents. Results: 52 questionnaires were included in the analysis; an overall response rate of 36% was achieved. A number of areas for improvement were identified, where levels of adherence were low; from initial screening and assessment - to appropriate onward referrals. No significant difference was found between responding trusts - with and without heart attack centres - in terms of guideline adherence. Discussion and conclusions: This survey has provided a ´snap shot´ of the provision of acute rehabilitation for patients with brain injury after cardiac arrest, in a number of hospital trusts across England. The results question the equity of acute rehabilitation for patients with brain injury after cardiac arrest; as adherence to guidelines varied between responding trusts, and individual trusts reported adhering to some guidelines only ´sometimes´. Further research into areas where adherence was low or varied is warranted. Added responses suggested that patient location within the trust was a factor influencing adherence to many of the guidelines, and as such it may be appropriate to review the patient pathway, with a view to improve consistency and quality of care. Impact and Implications: This study highlights the need for further guidance towards appropriate acute rehabilitation after cardiac arrest; particularly as more people are surviving cardiac arrest, and understanding how brain injury can impact on the lives of these patients and their families. Organisational support is needed to either further adopt the existing brain injury guidelines or to produce more specific guidelines for survivors of cardiac arrest. Funding Acknowledgement: Unfunded research. MSc Rehabilitation supported through CPPD contract, and staff at St George´s University Foundation Health Trust and Kingston University & St George´s University, London, Faculty of Health, Social Care and Education. Key-Words: Guidelines, Rehabilitation, cardiac arrest

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