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.
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 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).



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.
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK.
Tiffany
T
Patterson
Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, Warwick Medical School, University of Warwick, Coventry, UK.
Gavin D
GD
Perkins
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK.
Jubin
J
Joseph
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK.
Karen
K
Wilson
London School Of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK.
Laura
L
Van Dyck
London School Of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK.
Steven
S
Robertson
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK.
Hanna
H
Nguyen
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK.
Hannah
H
McConkey
London Ambulance Service, London, UK.
Mark
M
Whitbread
London Ambulance Service, London, UK.
Rachael
R
Fothergill
London Ambulance Service, London, UK.
Joanne
J
Nevett
Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Middlesex, UK.
Miles
M
Dalby
Department of Cardiology, Royal Free NHS Foundation Trust, London, UK.
Roby
R
Rakhit
Department of Cardiology, King's College Hospital NHS Foundation Trust, London,UK.
Philip
P
MacCarthy
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK.
Divaka
D
Perera
School of Clinical Sciences, University of Bristol and Department of Anaesthesia, Royal United Hospital, Bath, UK.
Jerry P
JP
Nolan
Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK. Electronic address: simon.redwood@gstt.nhs.uk.
Simon R
SR
Redwood
D000368:Aged; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer; D010865:Pilot Projects; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy*
Cardiac resuscitation centre; Coronary angiography; Out-of-hospital cardiac arrest