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
T2 - the ARREST pilot randomised trial
AU - Patterson, Tiffany
AU - Perkins, Gavin D.
AU - Joseph, Jubin
AU - Wilson, Karen
AU - Van Dyck, Laura
AU - Robertson, 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 - 2017/6/1
Y1 - 2017/6/1
N2 - 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.
AB - 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.
KW - Cardiac resuscitation centre
KW - Coronary angiography
KW - Out-of-hospital cardiac arrest
UR - http://www.scopus.com/inward/record.url?scp=85012867960&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2017.01.020
DO - 10.1016/j.resuscitation.2017.01.020
M3 - Article (Academic Journal)
C2 - 28174052
SN - 0300-9572
VL - 115
SP - 185
EP - 191
JO - Resuscitation
JF - Resuscitation
ER -