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Expedited transfer to cardiac arrest center vs standard care for non-ST elevation out-of-hospital cardiac arrest

22 Apr 2024
cardiac arrest

In a prospective, multicentre, parallel, randomised clinical trial titled ARREST, researchers aimed to evaluate the effectiveness of expedited transfer to a cardiac arrest center compared to standard care following out-of-hospital cardiac arrest. The ARREST study is the first randomized trial of its kind. Conducted in the UK, the study enrolled 862 patients aged 18 or older who experienced return of spontaneous circulation after cardiac arrest without ST elevation. Ambulance staff randomly assigned participants to receive expedited delivery to a cardiac catheter laboratory at one of seven designated cardiac arrest centers or standard care with delivery to the nearest emergency department.

Between January 15, 2018, and December 1, 2022, participants were followed up, and the primary outcome of all-cause mortality at 30 days was analyzed. The results indicated no significant difference in mortality rates between the two groups. Moreover, safety outcomes showed minimal serious adverse events, none of which were attributed to the trial intervention.

The authors concluded that expedited transfer to cardiac arrest centers following out-of-hospital cardiac arrest in adult patients without ST elevation did not result in reduced mortality rates, despite the well-resourced facilities available at these centers. These findings contribute to the ongoing discussion on optimal protocols for managing cardiac arrest cases outside of hospital settings. These results contradict previous observational studies suggesting a survival benefit at cardiac arrest centers but align with trials examining post-resuscitation care. The findings suggest that delivering patients to the nearest emergency department is a reasonable approach with similar outcomes in the UK healthcare setting.

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Original article: Patterson T. Lancet. 2023 Oct 14;402(10410):1329-1337.

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