[Accepted Manuscript] 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.
Patterson, T.;
Perkins, G.D.;
Joseph, J.;
Wilson, K.;
Van Dyck, L.;
Roberston, S.;
Nguyen, H.;
McConkey, H.;
Whitbread, M.;
Fothergill, R.;
+7 more...Nevett, J.;
Dalby, M.;
Rakhit, R.;
MacCarthy, P.;
Perera, D.;
Nolan, J.P.;
Redwood, S.R.;
(2017)
[Accepted Manuscript] 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.
ISSN 0300-9572
DOI: https://doi.org/10.1016/j.resuscitation.2017.01.020
(In Press)
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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.
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.
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 characteristicsbetween 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).
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.