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

• Published in: Resuscitation 2017-06, Vol.115, p.185-191
• Main 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
• Format: Article
• Language: English
• Subjects: Aged; Cardiac resuscitation centre; Cardiopulmonary Resuscitation; Case-Control Studies; Coronary angiography; Emergency; Feasibility Studies; Female; Hospitals, Special; Humans; Intention to Treat Analysis; Male; Middle Aged; Out-of-hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - etiology; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Outcome and Process Assessment, Health Care; Patient Transfer; Pilot Projects; Time Factors; Ventricular Fibrillation - complications; Ventricular Fibrillation - therapy
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2017.01.020

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.