Supporting Co-Survivors in Clinical Practice

When a patient survives a cardiac arrest, the clinical focus understandably centres on them. But in almost every case, there is someone else in that hospital — or at home, or at work — who witnessed what happened, who may have performed CPR, who has been living on adrenaline since the moment the heart stopped. That person is a co-survivor. And in the vast majority of cases, nobody has asked how they are.

This page is for the healthcare professionals, commissioners, and allied health staff who care for cardiac arrest survivors. It makes the case for proactively identifying and supporting co-survivors, summarises the evidence base, sets out what to look for in clinical encounters, and provides practical resources — including a recommended briefing paper available to download below.

Who Are Co-Survivors?

SCA UK uses the term co-survivor to describe anyone significantly affected by another person’s cardiac arrest. This includes partners and spouses (particularly those who performed CPR), parents, children, siblings, close friends, bystanders who intervened, and lay rescuers. The RCUK Quality Standards for Care and Rehabilitation of Cardiac Arrest Survivors — published in 2024 and supported by SCA UK — use the term key supporters and explicitly include them within the standards’ scope. The two terms are interchangeable in clinical use.

Co-survivors are not a small or incidental group. Given that the majority of out-of-hospital cardiac arrests occur in the home, and that bystander CPR rates in the UK are increasing, most cardiac arrest survivors arrive at hospital having been resuscitated by someone who loves them. That person’s experience — and their subsequent psychological trajectory — is a clinical matter, not merely a personal one.

The Evidence for Co-Survivor Impact

The psychological burden carried by co-survivors is well-documented, though it remains poorly translated into routine clinical practice. Key findings from the literature include:

Rates of PTSD, anxiety, and depression among co-survivors are broadly comparable to those seen in survivors themselves, with some studies suggesting co-survivor PTSD rates of 20–40% in the months following the event.
Partners who performed CPR carry a particularly high psychological burden. The physical act of resuscitating a loved one creates powerful intrusive memories, and paradoxical guilt responses — including guilt when the person survived — are common and clinically significant.
Anticipatory anxiety — a persistent, hypervigilant fear of recurrence — is reported in the majority of co-survivors and frequently persists at the 12-month mark without intervention.
Role transition from partner or family member to informal carer is a major source of strain, identity disruption, and social isolation, particularly when it occurs rapidly and without support.
Untreated co-survivor distress is associated with poorer survivor outcomes. When those closest to a survivor are struggling, the relational environment — which is central to psychological recovery — is compromised for both parties.

The CARESearch Hub is a freely accessible, living evidence repository covering survivorship outcomes after cardiac arrest, including psychological and relational sequelae, and is a useful starting point for professionals seeking a deeper evidence base.

What the RCUK Quality Standards Say

The 2024 RCUK Survivorship Quality Standards are explicit that co-survivors — referred to as key supporters — should be included in discharge assessment and follow-up. Specifically, the standards recommend:

A pre-discharge assessment that considers the psychological and practical needs of key supporters alongside those of the survivor
A three-month follow-up that offers assessment and onward referral for key supporters experiencing distress
Long-term re-access to services for key supporters if new difficulties emerge, acknowledging that distress does not always manifest immediately

These standards represent a significant step forward. However, implementation remains inconsistent, and many co-survivors currently reach SCA UK having had no formal psychological screening or follow-up offer at any point in their care pathway. There is a substantial gap between the standard and the reality — and professionals at every stage of that pathway have an opportunity to close it.

Identifying Co-Survivor Distress in Clinical Encounters

Co-survivor distress is frequently invisible at the bedside. Co-survivors are often in a functional, practical mode during clinical encounters — asking questions, taking notes, coordinating care — and may not present as distressed even when they are. Several factors compound this:

Co-survivors frequently do not feel entitled to their own distress and may actively minimise it when asked, particularly if the survivor is present
The healthcare system rarely creates a separate space for co-survivors to be asked directly about their own experience — questions are typically directed at the patient
Co-survivors may not recognise their own symptoms as clinically significant — hypervigilance, intrusive memories, and sleep disturbance may be attributed to normal worry rather than trauma
Where CPR was performed, guilt and shame can make disclosure difficult; co-survivors may fear being perceived as seeking attention at the expense of the survivor

A simple, direct question — asked separately from the patient where possible — can make an enormous difference: “How are you doing through all of this? Not as a carer, but as a person who went through something very frightening.” Normalising the question, and the distress it may reveal, is itself a therapeutic act.

Brief validated screening tools appropriate for use with co-survivors include the GAD-7 (generalised anxiety), PHQ-9 (depression), and the PCL-5 (PTSD checklist). These are in routine use in many cardiac rehabilitation settings and are straightforwardly applicable to co-survivors.

A Trauma-Informed Approach to Co-Survivor Care

Understanding co-survivor distress through a trauma-informed lens — asking “what happened to you?” rather than “what is wrong with you?” — changes both the nature of clinical conversations and the appropriateness of interventions. Trauma-informed care is not a specific therapeutic modality; it is a framework for how services relate to people who have experienced overwhelming events. Its core principles — safety, trustworthiness, collaboration, empowerment, and cultural sensitivity — are as applicable to the co-survivor at a six-week outpatient appointment as they are to any other clinical encounter.

In January 2026, Imroc — a registered charity led by lived experience and dedicated to improving care for people with mental health conditions — published a briefing paper by Anna Cheetham and Katie Mottram: Trauma Informed and Trauma Responsive Care: An Introduction. The paper provides a thorough, accessible, and clinically grounded introduction to trauma-informed practice, covering the neurobiology of trauma, the 4Rs framework (Realise, Recognise, Respond, Resist Re-traumatisation), trauma in organisations, and the centrality of relational safety to recovery. It is the most accessible single document currently available on trauma-informed approaches in a UK mental health context, and is directly applicable to the cardiac arrest survivorship setting.

SCA UK recommends it as reading for any professional working with survivors and co-survivors. It is free to download below, with permission of the authors and Imroc. Further publications from Imroc are available at imroc.org/publications.

Download: Trauma Informed and Trauma Responsive Care

Trauma Informed and Trauma Responsive Care: An Introduction — Anna Cheetham and Katie Mottram. Published by Imroc, January 2026.

Trauma Informed and Trauma Responsive Care — Cheetham and Mottram, Imroc 2026 Download

Signposting Co-Survivors to Support

Where co-survivor distress is identified, the following resources are appropriate for onward signposting:

SCA UK — Co-Survivors page — written directly for co-survivors, covering what they experience and where to find support. Suitable for sharing at discharge or follow-up.
I Care leaflet — SCA UK’s free PDF resource for partners, family members, and friends of cardiac arrest survivors. Designed for distribution at discharge.
Chain of Survival leaflet — for those who witnessed or participated in a resuscitation attempt, including bystander rescuers.
NHS Talking Therapies — self-referral available in most areas of England; appropriate for co-survivors meeting criteria for anxiety, depression, or PTSD.
Carers UK — for co-survivors who have moved into a caring role, including guidance on carer’s assessments and entitlements.
SCA UK community — peer support for co-survivors and survivors. Many co-survivors describe community connection as the most significant factor in their own recovery.

Working With SCA UK

SCA UK supports clinical teams in building co-survivor awareness into their pathways. We can provide resources for distribution at discharge, contribute the lived-experience voice to service improvement work, and support staff training on co-survivor needs. If you would like to discuss how we can work together, please visit our Bridging the Gap page or get in touch directly.