In adult patients without ST elevation, expedited transfer by ambulance to a cardiac arrest center following resuscitation from an out-of-hospital cardiac arrest (OHCA) did not reduce deaths compared with transfer to the closest emergency department, based on findings from the ARREST trial presented at ESC Congress 2023 and simultaneously published in The Lancet.

Researchers out of the UK randomly assigned 862 patients (32% women), who were resuscitated following OHCA and who did not show signs of ST-elevation on their post-resuscitation electrocardiogram (ECG), to one of seven cardiac arrest centers in London (n=431) or the geographically closest emergency department at one of 32 hospitals in the city (n=431). The primary outcome was all-cause mortality at 30 days, analyzed in the intention-to-treat (ITT) population excluding those with unknown mortality status (n=822). Safety outcomes were also analyzed in the ITT population.

In overall findings, the primary endpoint of 30-day mortality occurred in 258 (63%) of the participants sent to cardiac arrest centers compared with 258 (63%) those sent to the closest emergency. Eight patients in the cardiac arrest center group and three in the emergency department group experienced serious adverse events, none of which were deemed related to the trial intervention, according to the researchers. In addition, there was no difference in the secondary endpoint of three-month all-cause mortality between the two groups and neurological outcomes were similar at hospital discharge and at three months.

"This study does not support transportation of all patients to a cardiac arrest center following resuscitated cardiac arrest within this health care setting," said Tiffany Patterson, MD, of Guy's and St Thomas' NHS Foundation Trust, London, UK. "Cardiac arrest centers are heavily resourced hospitals. If delivering these patients to such centers to receive multiple interventions does not improve overall survival, then these resources are better allocated elsewhere. Furthermore, if cardiac arrest patients are not taken to such hospitals, this frees up space for other emergency work – including trauma, STEMI and acute aortic dissection – that requires high-dependency beds and the specialist input provided by these centers."

In a related editorial comment, Carolina Malta Hansen, MD; Fredrik Folke, MD, PhD; and Christopher B. Granger, MD, FACC, note that "prioritizing a minimum standard of care at local hospitals caring for this population is at least as important as ensuring high-quality care or advanced treatment at tertiary centers." They go on to write that the ARREST trial underscores the need for "more focus on the basics, including efforts to increase bystander cardiopulmonary resuscitation and early defibrillation, aspects of care that are … most strongly associated with improved survival, when coupled with high-quality prehospital care with trained staff and short response times."

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: ESC Congress, ESC23, ACC International, Out-of-Hospital Cardiac Arrest, Heart Arrest, Emergency Service, Hospital

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