Expedited transfer to a specialised centre does not improve cardiac arrest outcomes

Patients with resuscitated out-of-hospital cardiac arrest (OHCA) without ST elevation did not benefit from immediate transfer to a specialised cardiac arrest centre compared with a transfer to the nearest emergency department in terms of survival or neurological outcomes. These were the main results of the ARREST trial.

“There are regional differences in cardiac arrest survival due to variations in infrastructure, resources, and personnel,” Dr Tiffany Patterson (King’s College London, UK) pointed out [1]. “The standard-of-care for patients with resuscitated OHCA is to transfer them to the nearest emergency department. However, post-arrest care may best be delivered at a specialised centre.” The ARREST trial (NCT03880565) assessed whether transferring patients with resuscitated non-ST elevated OHCA to a specialised centre improves their chance of survival compared with delivery to the nearest emergency department [1,2]. The study included 32 emergency departments and 7 specialised cardiac arrest centres in London. Ambulance paramedics randomised pre-hospital patients (n=862) 1:1 to either a transfer to the nearest emergency department or a transfer to a specialised care centre. The primary outcome was 30-day all-cause mortality.

At 30 days, no differences were observed between the standard-of-care/emergency department group and the cardiac arrest centre group in terms of 30-day all-cause mortality (risk ratio 1.00; 95% CI 0.90–1.11; P=0.96). Secondary outcomes, such as 3-month mortality and neurological outcomes at discharge, confirmed that transfer to a specialised cardiac arrest centre did not result in significant health benefits for patients.

1. 
   
   1. Patterson T, et al. ARREST Trial: expedited transfer to a cardiac arrest centre for non-ST elevation OHCA. Hot Line Session 5, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.
   2. Patterson T, et al. Lancet. 2023; Aug 27. DOI:10.1016/S0140-6736(23)01351-X.

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Posted on 30 October 202330 October 2023