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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
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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
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Official URL: http://dx.doi.org/10.1016/j.resuscitation.2017.01....
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 Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School |
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| 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: |
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| Date of first compliant deposit: | 20 April 2017 | ||||||
| DOI: | 10.1016/j.resuscitation.2017.01.020 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||
| Funder: | ZOLL Medical Corporation, British Heart Foundation | ||||||
| Grant number: | CS/16/3/32615 (British Heart Foundation) |
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