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. (June 2017)

• Record Type: Journal Article
• Authors: Patterson, Tiffany; Perkins, Gavin D.; Joseph, Jubin; Wilson, Karen; Van Dyck, Laura; Robertson, Steven; Nguyen, Hanna; McConkey, Hannah; Whitbread, Mark; Fothergill, Rachael; Nevett, Joanne; Dalby, Miles; Rakhit, Roby; MacCarthy, Philip; Perera, Divaka; Nolan, Jerry P.; Redwood, Simon R.
• Is Part Of: Resuscitation. Volume 115(2017)
• Page Start: 185
• Page End: 191
• Publication Date: 2017-06
• Subjects: Out-of-hospital cardiac arrest -- Cardiac resuscitation centre -- Coronary angiography; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.01.020
• Languages: English
• ISSNs: 0300-9572

Abstract

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.