Quality standard
Quality statement 5: Level of consciousness and eligibility for coronary angiography and primary PCI
Quality statement 5: Level of consciousness and eligibility for coronary angiography and primary PCI
Quality statement
Adults who are unconscious after cardiac arrest caused by suspected acute ST‑segment‑elevation myocardial infarction (STEMI) are not excluded from having coronary angiography (with follow-on primary percutaneous coronary intervention [PCI] if indicated).
Rationale
People who remain unconscious after cardiac arrest should not be treated differently from people who are conscious. They should be able to have the same treatments within the same timescales and should be admitted to centres capable of undertaking primary PCI. Carrying out immediate primary PCI, if successful, could stabilise the person's heart and may reduce the risk of further complications.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults who are unconscious after cardiac arrest caused by suspected acute STEMI are not excluded from having coronary angiography (with follow-on primary PCI if indicated) because they are unconscious.
Data source: Local data collection.
Process
Proportion of adults who were unconscious after cardiac arrest caused by suspected acute STEMI who receive coronary angiography (with follow-on primary PCI if indicated).
Numerator – the number in the denominator receiving coronary angiography (with follow-on primary PCI if indicated).
Denominator – the number of adults who were unconscious after cardiac arrest caused by suspected acute STEMI.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (ambulance services and cardiac service providers) ensure that adults who are unconscious after cardiac arrest caused by suspected acute STEMI are not excluded from having coronary angiography (with follow-on primary PCI if indicated). Providers should also raise awareness among healthcare professionals of the importance of not using level of consciousness to exclude adults from having coronary angiography (with follow-on primary PCI if indicated).
Healthcare professionals ensure that they do not use level of consciousness after cardiac arrest caused by suspected acute STEMI to exclude adults from having coronary angiography (with follow-on primary PCI if indicated).
Commissioners ensure that they commission services that can carry out coronary angiography (with follow-on primary PCI if indicated) in adults who are unconscious after cardiac arrest caused by suspected acute STEMI.
Adults who are unconscious after a type of heart attack called STEMI can have a test called coronary angiography, and treatment to improve blood flow to the heart if needed, even though they are unconscious.
Source guidance
Acute coronary syndromes. NICE guideline NG185 (2020), recommendation 1.1.2