Figures for the number of cardiac arrests occurring outside of a hospital (OHCAs) in Northern Ireland have been collected and analysed for the first time, providing comprehensive data over the five years to 2022 in Northern Ireland.
The research was carried out as a collaboration between academics at Queen’s University Belfast and the Northern Ireland Ambulance Service (NIAS) and was funded by local health charity Northern Ireland Chest Heart and Stroke (NICHS).
As well as providing a new, baseline database, the report allows comparisons to areas where NI is performing well relative to other parts of the UK/ROI and international OHCA findings. It also allows identification of areas where improvements could be made in NI.
Experts said the findings underlined the importance of a better resourced health service; training more members of the public in cardio-pulmonary resuscitation (CPR) skills; and increasing knowledge about defibrillators and how to use them. Among the key findings are:
14,255 OHCAs were attended by NIAS between 2018-2022. Over 55% patients were declared dead at the scene upon arrival of NIAS. Resuscitation attempts were made on the remaining 45% (6,415 patients) and from these, 37% were transported to hospital by NIAS
Of the OHCAs, 63.9% were male, 35.4% female. The mean age was 64.5 years old. The assumed reasons for the OHCAs were: Medical (86.5%); Asphyxiation including from hanging (4.9%); Drug overdose (4%); Trauma (3.9%); Drowning or Electrocution (0.8%)
Comparisons can be made for 2022 between the NI attempted resuscitation rate (47.8%) and the England rate (35.1%)
By 2022, OHCAs in NI had increased by an extra seven cardiac arrests per week, compared with 2018. Covid may have had an impact on this
Between 2020-2022, for the most time-critical 999 calls (Category 1 calls), the NI ambulance response time was 10.7 mins, compared to the recommended UK 8-mins target
Although NI had a longer response rate than the national target, NIAS still arrived to 21% shockable OHCA rhythms, comparable to England (21%), Scotland (22.5%) and ROI (22%) in 2022.
When a bystander witnessed the cardiac arrest in NI, an average of 87.5% of patients received CPR before an ambulance arrived. This is compared to 79.6% in England and 87% in ROI
When the OHCA itself was not witnessed but help came later, 70.3% of patients in NI received CPR from a friend / family / member of the public
Only 5% of patients in NI received a shock from a defibrillator before ambulance arrival across the five-year period. In 2022, the NI rate was 7.4% compared to 8.5% (England); 8% (Scotland); and 10% (ROI)
Over the five-year period, 23% of NI patients had their heart restarted before reaching hospital through the combined efforts of bystanders, emergency services and healthcare staff and another 14% receiving ongoing CPR in the ambulance on their way to hospital. For the year 2022, the NI figure was 24.6% which is consistent with 25.8% (England) and 27.7% (Scotland) and higher than 18.6% (ROI)
- The average percentage of patients receiving CPR before an ambulance arrived – including bystander-witness and non-bystander-witnessed – increased from 70% in 2018 to 79% in 2022
Lead Queen's author on the report, Professor Adele Marshall of the School of Mathematics and Physics at Queen’s University said the data was a necessary starting point to improving survival rates. She said:
“This is the evidence base which can inform public-health policy and education around such a significant public-health challenge. I hope these statistics give policy-makers and the charity sector the information they need to make wise decisions about how to prioritise resources.
“It also highlights the essential part the general public has to play by getting CPR training and knowing how to quickly locate and use a defibrillator. Personally, I’d support a policy change where everyone doing a driving test had to be fully trained in CPR and locating/using a defibrillator.
“Considering that the portable defibrillator was invented by a Queen’s University academic, Professor Frank Pantridge, it feels appropriate that Queen’s has collaborated with NIAS on this study and continues to provide research to evidence important improvements in this critical aspect of public health.”
Julia Wolfe, Research and Development Lead for the NIAS said:
“Survival depends on several factors, from how quickly CPR and defibrillation are delivered to the speed of emergency response and the quality of subsequent care. By understanding these factors and the data behind them, we can identify opportunities to improve outcomes and strengthen every link in the chain of survival.”
Neil Sinclair, Chief Paramedic Officer for the NIAS said:
“The report shows encouraging progress in bystander CPR, but also identifies clear
opportunities to strengthen the chain of survival. Improving access to early defibrillation and reducing ambulance response times, alongside targeted prevention for avoidable causes of OHCA, will be important areas of focus to improve outcomes across Northern Ireland.”
Fidelma Carter, Head of Public Health at NICHS, added:
"As NICHS marks its 80th anniversary, we are proud to have funded this landmark piece of research, the first comprehensive study of out-of-hospital cardiac arrest undertaken by the Northern Ireland Ambulance Service. Every cardiac arrest is a race against time, and this research gives us an invaluable evidence base to better understand where lives can be saved and how we can strengthen every link in the chain of survival for future generations.
“One of the biggest findings to emerge from this report is that although bystander CPR is on the rise, there is still room for improvement, and a lot of people don’t know where their nearest defibrillator is or how to use it correctly. Given the well-documented pressures on the health service, including the ambulance service, that is something we need to improve – to get the message out there that all of us, as citizens and individuals, can potentially make a difference.”
A copy of the report can be found here: Out_of_hospital_cardiac_arrest_in_Northern_Ireland._A_5_year_review_2026.pdf
To mark Restart a Heart Day, NIAS and NICHS will be hosting pop-up bystander CPR training and defibrillator awareness sessions for the public on Friday 16 October, at Victoria Square shopping centre, Belfast from 10am-6pm. All are welcome.
