A Randomised Trial of Expedited Transfer to a Cardiac Arrest Centre for Non-ST Elevation Out-of-hospital Cardiac Arrest (ARREST)
Out-Of-Hospital Cardiac Arrest
About this trial
This is an interventional treatment trial for Out-Of-Hospital Cardiac Arrest focused on measuring cardiac arrest, pre-hospital care, strategy trial
Eligibility Criteria
Inclusion Criteria:
- Out-of-hospital cardiac arrest (OHCA)
- Return of spontaneous circulation (ROSC)
- Age 18 or over (known or presumed)
- Absence of non-cardiac cause (for example; trauma, drowning, suicide, drug overdose)
Exclusion Criteria:
- Criteria for ST-elevation myocardial infarction on 12-Lead electrocardiogram (ECG)
- Do Not Attempt Resuscitation (DNAR) Order
- Cardiac arrest suffered after care pathway set and patient en route
- Suspected pregnancy
Sites / Locations
- Dartford and Gravesham NHS Trust
- Barts Health NHS Trust
- BHR University Hospitals NHS Trust
- Chelsea and Westminster Hospital NHS Foundation Trust
- Croydon Health Services NHS Trust
- Epsom and St Helier University Hospitals NHS Trust
- Guy's and St Thomas' NHS FT
- Hillingdon Hospitals NHS Trust
- Homerton University Hospital NHS Trust
- Imperial College Healthcare NHS Trust
- King's College Hospital NHS Foundation Trust
- Kingston Hospital NHS FT
- Lewisham & Greenwich NHS Trust
- London Ambulance Service NHS Trust
- London North West University Healthcare
- North Middlesex University Hospital NHS Trust
- Royal Brompton and Harefield NHS Trust
- Royal Free London NHS Foundation Trust
- St George's University Hospitals NHS Foundation Trust
- Surrey and Sussex Healthcare NHS Trust
- University College London Hospitals NHS Foundation Trust
- West Hertfordshire Hospitals NHS Trust
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Intervention Arm: Expedited transfer to a CAC
Control Arm: Current standard of care
The intervention arm consists of activation of the pre-hospital triaging system currently in place for post-arrest STE patients. This involves pre-alert of the CAC and strategic delivery of the patient to the catheter laboratory (24 hours a day, 7 days a week). Patients will receive definitive post-resuscitation care: intubation and ventilation, where necessary, targeted temperature management, and goal directed therapies including evaluation and identification of underlying cause of arrest with access to immediate reperfusion if necessary. Prognostication will occur no earlier than 72 hours post-cardiac arrest to prevent premature withdrawal of life-sustaining treatment. Transfer times estimated from the 40-patient pilot are anticipated to be 100 minutes (median; IQR 75 to 113) from time of arrest to the designated centre.
The control arm comprises the current standard of pre-hospital advanced life support (ALS) care management for patients with ROSC following cardiac arrest of suspected cardiac aetiology. The patient is conveyed to the geographically closest emergency department. Management thereafter will be as per standard hospital protocols however as in the intervention arm, prognostication is to be delayed in trial patients until at least 72 hours post arrest.