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Resuscitation. 2017 Jun;115:185-191. doi: 10.1016/j.resuscitation.2017.01.020. Epub 2017 Feb 4.

A Randomised tRial of Expedited transfer to a cardiac arrest centre for non-ST elevation ventricular fibrillation out-of-hospital cardiac arrest: The ARREST pilot randomised trial.

Author information

1
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK.
2
Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, Warwick Medical School, University of Warwick, Coventry, UK.
3
London School Of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK.
4
London Ambulance Service, London, UK.
5
Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Middlesex, UK.
6
Department of Cardiology, Royal Free NHS Foundation Trust, London, UK.
7
Department of Cardiology, King's College Hospital NHS Foundation Trust, London,UK.
8
School of Clinical Sciences, University of Bristol and Department of Anaesthesia, Royal United Hospital, Bath, UK.
9
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK. Electronic address: simon.redwood@gstt.nhs.uk.

Abstract

BACKGROUND:

Wide variation exists in inter-hospital survival from out-of-hospital cardiac arrest (OHCA). Regionalisation of care into cardiac arrest centres (CAC) may improve this. We report a pilot randomised trial of expedited transfer to a CAC following OHCA without ST-elevation. The objective was to assess the feasibility of performing a large-scale randomised controlled trial.

METHODS:

Adult witnessed ventricular fibrillation OHCA of presumed cardiac cause were randomised 1:1 to either: (1) treatment: comprising expedited transfer to a CAC for goal-directed therapy including access to immediate reperfusion, or (2) control: comprising current standard of care involving delivery to the geographically closest hospital. The feasibility of randomisation, protocol adherence and data collection of the primary (30-day all-cause mortality) and secondary (cerebral performance category (CPC)) and in-hospital major cardiovascular and cerebrovascular events (MACCE) clinical outcome measures were assessed.

RESULTS:

Between November 2014 and April 2016, 118 cases were screened, of which 63 patients (53%) met eligibility criteria and 40 of the 63 patients (63%) were randomised. There were no protocol deviations in the treatment arm. Data collection of primary and secondary outcomes was achieved in 83%. There was no difference in baseline characteristics between the groups: 30-day mortality (Intervention 9/18, 50% vs. Control 6/15, 40%; P=0.73), CPC 1/2 (Intervention: 9/18, 50% vs. Control 7/14, 50%; P>0.99) or MACCE (Intervention: 9/18, 50% vs. Control 6/15, 40%; P=0.73).

CONCLUSIONS:

These findings support the feasibility and acceptability of conducting a large-scale randomised controlled trial of expedited transfer to CAC following OHCA to address a remaining uncertainty in post-arrest care.

KEYWORDS:

Cardiac resuscitation centre; Coronary angiography; Out-of-hospital cardiac arrest

[Indexed for MEDLINE]

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