King's College London

TY - JOUR

T1 - 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

AU - Patterson, Tiffany

AU - Perkins, Gavin D.

AU - Joseph, Jubin

AU - Wilson, Karen

AU - Van Dyck, Laura

AU - Roberston, Steven

AU - Nguyen, Hanna

AU - McConkey, Hannah

AU - Whitbread, Mark

AU - Fothergill, Rachael

AU - Nevett, Joanne

AU - Dalby, Miles

AU - Rakhit, Roby

AU - MacCarthy, Philip

AU - Perera, Divaka

AU - Nolan, Jerry P.

AU - Redwood, Simon R.

PY - 2017/6

Y1 - 2017/6

N2 - BackgroundWide 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.MethodsAdult 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.ResultsBetween 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).ConclusionsThese 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.

AB - BackgroundWide 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.MethodsAdult 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.ResultsBetween 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).ConclusionsThese 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.

KW - Out-of-hospital Cardiac Arrest

KW - Cardiac Resuscitation Centre

KW - Coronary Angiography

U2 - 10.1016/j.resuscitation.2017.01.020

DO - 10.1016/j.resuscitation.2017.01.020

M3 - Article

VL - 115

SP - 185

EP - 191

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -