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    A randomised trial of expedited transfer to a cardiac arrest centre for non-ste out-of-hospital cardiac arrest: arrest

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    Author
    Patterson, Tiffany
    Perkins, Gavin D.
    Joseph, Jubin
    Wilson, Karen
    Van Dyck, Laura
    Robertson, Steven
    Nguyen, Hanna
    McConkey, Hannah
    Whitbread, Mark
    Fothergill, Rachael cc
    Nevett, Joanne
    Dalby, Miles C.
    Rakhit, Roby D.
    McCarthy, Philip A.
    Perera, Divaka
    Nolan, Jerry P.
    Redwood, Simon R.
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    Keyword
    Emergency Medical Services
    Cerebrovascular Disorders
    Out-of-Hospital Cardiac Arrest (OHCA)
    Assessment Skills
    Referral and Consultation
    Journal title
    Heart
    
    Metadata
    Show full item record
    URI
    http://hdl.handle.net/20.500.12417/357
    DOI
    10.1136/heartjnl-2018-BCIS.13
    Abstract
    Background Wide variation exists in inter-hospital survival from 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 RCT. Methods Adult witnessed VF OHCA of presumed cardiac cause were randomised 1:1 to either: (1) intervention: expedited transfer to a CAC for goal-directed therapy including access to immediate reperfusion, or (2) control: 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 Nov 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 (Int 9/18, 50% vs Control 6/15, 40%; p=0.73), CPC 1/2 (Int: 9/18, 50% vs Control 7/14, 50%; p>0.99) or MACCE (Int: 9/18, 50% vs Control 6/15, 40%; p=0.73). Conclusions These findings support the feasibility of conducting a large-scale RCT to address a remaining uncertainty in post-arrest care. https://heart.bmj.com/content/104/Suppl_1/A7.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/heartjnl-2018-BCIS.13
    ae974a485f413a2113503eed53cd6c53
    10.1136/heartjnl-2018-BCIS.13
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    Publications - London Ambulance Service

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