Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm

Rupert F G Simpson; Thomas Johnson; Paul Rees; Guy Glover; Uzma Sajjad; Samer Fawaz; Sarosh Khan; Emma Beadle; Daryl Perilla; Maria Maccaroni; Christopher Cook; Marco Mion; Qiang Xue; Rohan Jagathesan; Gerald J Clesham; Tom Quinn; Johannes Von Vopelius-Feldt; Sean Gallagher; Abdul Mozid; Ellie Gudde; Carl Smith; Pammi Warwick; Tom Abell; Neal Durge; Grigoris V Karamasis; Nick Curzen; John R Davies; Nilesh Pareek; Thomas R Keeble

doi:10.1016/j.resuscitation.2025.110491

Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm

Rupert F G Simpson, Thomas Johnson, Paul Rees, Guy Glover, Uzma Sajjad, Samer Fawaz, Sarosh Khan, Emma Beadle, Daryl Perilla, Maria Maccaroni, Christopher Cook, Marco Mion, Qiang Xue, Rohan Jagathesan, Gerald J Clesham, Tom Quinn, Johannes Von Vopelius-Feldt, Sean Gallagher, Abdul Mozid, Ellie GuddeCarl Smith, Pammi Warwick, Tom Abell, Neal Durge, Grigoris V Karamasis, Nick Curzen, John R Davies, Nilesh Pareek, Thomas R Keeble

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

BACKGROUND AND AIMS: Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.

METHODS: This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.

RESULTS: Of 330 patients (mean age 67.5 ± 13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98-1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95-1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05-2.13) p = 0.02 and in those with a MIRACLE 2 score ≤ 5 [(63%% vs 38%, RR 0.59 (95% CI 0.61-0.86) p = 0.005].

CONCLUSIONS: The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE 2 score, to a dedicated CAC may improve survival.

Original language	English
Article number	110491
Journal	Resuscitation
Volume	207
Early online date	4 Jan 2025
DOIs	https://doi.org/10.1016/j.resuscitation.2025.110491
Publication status	Published - 1 Feb 2025

Bibliographical note

Publisher Copyright:
© 2025 Elsevier B.V.

Keywords

Humans
Out-of-Hospital Cardiac Arrest/therapy
Male
Female
Pilot Projects
Aged
Algorithms
Feasibility Studies
ST Elevation Myocardial Infarction/complications
Emergency Medical Services/methods
Cardiopulmonary Resuscitation/methods
United Kingdom/epidemiology
Middle Aged
Electric Countershock/methods
Time-to-Treatment

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Simpson, R. F. G., Johnson, T., Rees, P., Glover, G., Sajjad, U., Fawaz, S., Khan, S., Beadle, E., Perilla, D., Maccaroni, M., Cook, C., Mion, M., Xue, Q., Jagathesan, R., Clesham, G. J., Quinn, T., Vopelius-Feldt, J. V., Gallagher, S., Mozid, A., ... Keeble, T. R. (2025). Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm. Resuscitation, 207, Article 110491. https://doi.org/10.1016/j.resuscitation.2025.110491

@article{e87fdcbd1ad44ecd862a3fe4fc98edb0,

title = "Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm",

abstract = "BACKGROUND AND AIMS: Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.METHODS: This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.RESULTS: Of 330 patients (mean age 67.5 ± 13.1, 66\% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81\% vs 73\%, RR 1.10 (95\% CI 0.98-1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15\% vs 19\%, RR 1.05 (0.95-1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61\% vs 41\%, RR 1.5 (95\% CI 1.05-2.13) p = 0.02 and in those with a MIRACLE 2 score ≤ 5 [(63\%\% vs 38\%, RR 0.59 (95\% CI 0.61-0.86) p = 0.005]. CONCLUSIONS: The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE 2 score, to a dedicated CAC may improve survival. ",

keywords = "Humans, Out-of-Hospital Cardiac Arrest/therapy, Male, Female, Pilot Projects, Aged, Algorithms, Feasibility Studies, ST Elevation Myocardial Infarction/complications, Emergency Medical Services/methods, Cardiopulmonary Resuscitation/methods, United Kingdom/epidemiology, Middle Aged, Electric Countershock/methods, Time-to-Treatment",

author = "Simpson, \{Rupert F G\} and Thomas Johnson and Paul Rees and Guy Glover and Uzma Sajjad and Samer Fawaz and Sarosh Khan and Emma Beadle and Daryl Perilla and Maria Maccaroni and Christopher Cook and Marco Mion and Qiang Xue and Rohan Jagathesan and Clesham, \{Gerald J\} and Tom Quinn and Vopelius-Feldt, \{Johannes Von\} and Sean Gallagher and Abdul Mozid and Ellie Gudde and Carl Smith and Pammi Warwick and Tom Abell and Neal Durge and Karamasis, \{Grigoris V\} and Nick Curzen and Davies, \{John R\} and Nilesh Pareek and Keeble, \{Thomas R\}",

note = "Publisher Copyright: {\textcopyright} 2025 Elsevier B.V.",

year = "2025",

month = feb,

day = "1",

doi = "10.1016/j.resuscitation.2025.110491",

language = "English",

volume = "207",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Science Ireland",

}

Simpson, RFG, Johnson, T, Rees, P, Glover, G, Sajjad, U, Fawaz, S, Khan, S, Beadle, E, Perilla, D, Maccaroni, M, Cook, C, Mion, M, Xue, Q, Jagathesan, R, Clesham, GJ, Quinn, T, Vopelius-Feldt, JV, Gallagher, S, Mozid, A, Gudde, E, Smith, C, Warwick, P, Abell, T, Durge, N, Karamasis, GV, Curzen, N, Davies, JR, Pareek, N & Keeble, TR 2025, 'Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm', Resuscitation, vol. 207, 110491. https://doi.org/10.1016/j.resuscitation.2025.110491

Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm. / Simpson, Rupert F G; Johnson, Thomas; Rees, Paul et al.
In: Resuscitation, Vol. 207, 110491, 01.02.2025.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm

AU - Simpson, Rupert F G

AU - Johnson, Thomas

AU - Rees, Paul

AU - Glover, Guy

AU - Sajjad, Uzma

AU - Fawaz, Samer

AU - Khan, Sarosh

AU - Beadle, Emma

AU - Perilla, Daryl

AU - Maccaroni, Maria

AU - Cook, Christopher

AU - Mion, Marco

AU - Xue, Qiang

AU - Jagathesan, Rohan

AU - Clesham, Gerald J

AU - Quinn, Tom

AU - Vopelius-Feldt, Johannes Von

AU - Gallagher, Sean

AU - Mozid, Abdul

AU - Gudde, Ellie

AU - Smith, Carl

AU - Warwick, Pammi

AU - Abell, Tom

AU - Durge, Neal

AU - Karamasis, Grigoris V

AU - Curzen, Nick

AU - Davies, John R

AU - Pareek, Nilesh

AU - Keeble, Thomas R

PY - 2025/2/1

Y1 - 2025/2/1

N2 - BACKGROUND AND AIMS: Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.METHODS: This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.RESULTS: Of 330 patients (mean age 67.5 ± 13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98-1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95-1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05-2.13) p = 0.02 and in those with a MIRACLE 2 score ≤ 5 [(63%% vs 38%, RR 0.59 (95% CI 0.61-0.86) p = 0.005]. CONCLUSIONS: The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE 2 score, to a dedicated CAC may improve survival.

AB - BACKGROUND AND AIMS: Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.METHODS: This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.RESULTS: Of 330 patients (mean age 67.5 ± 13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98-1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95-1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05-2.13) p = 0.02 and in those with a MIRACLE 2 score ≤ 5 [(63%% vs 38%, RR 0.59 (95% CI 0.61-0.86) p = 0.005]. CONCLUSIONS: The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE 2 score, to a dedicated CAC may improve survival.

KW - Humans

KW - Out-of-Hospital Cardiac Arrest/therapy

KW - Male

KW - Female

KW - Pilot Projects

KW - Aged

KW - Algorithms

KW - Feasibility Studies

KW - ST Elevation Myocardial Infarction/complications

KW - Emergency Medical Services/methods

KW - Cardiopulmonary Resuscitation/methods

KW - United Kingdom/epidemiology

KW - Middle Aged

KW - Electric Countershock/methods

KW - Time-to-Treatment

U2 - 10.1016/j.resuscitation.2025.110491

DO - 10.1016/j.resuscitation.2025.110491

M3 - Article (Academic Journal)

C2 - 39761908

SN - 0300-9572

VL - 207

JO - Resuscitation

JF - Resuscitation

M1 - 110491

ER -

Simpson RFG, Johnson T, Rees P, Glover G, Sajjad U, Fawaz S et al. Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm. Resuscitation. 2025 Feb 1;207:110491. Epub 2025 Jan 4. doi: 10.1016/j.resuscitation.2025.110491