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. and Redwood, Simon R. (2017) 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. Resuscitation . doi:10.1016/j.resuscitation.2017.01.020 ISSN 0300-9572.

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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.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Cardiac arrest, Cardiac arrest--Treatment , Cardiac resuscitation, Ventricular fibrillation
Journal or Publication Title:	Resuscitation
Publisher:	Elsevier Ireland Ltd
ISSN:	0300-9572
Official Date:	4 February 2017
Dates:	Date Event 4 February 2017 Available 24 January 2017 Accepted
DOI:	10.1016/j.resuscitation.2017.01.020
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	20 April 2017
Date of first compliant Open Access:	4 February 2018
Funder:	ZOLL Medical Corporation, British Heart Foundation
Grant number:	CS/16/3/32615 (British Heart Foundation)

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