{"id":138040,"date":"2023-08-27T12:20:37","date_gmt":"2023-08-27T16:20:37","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138040"},"modified":"2023-08-27T12:20:37","modified_gmt":"2023-08-27T16:20:37","slug":"arrest-transfer-to-a-cardiac-arrest-center-instead-of-the-nearest-ed-does-not-improve-mortality-in-ohca-patients","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138040","title":{"rendered":"ARREST: Transfer to a cardiac arrest center instead of the nearest ED does not improve mortality in OHCA patients"},"content":{"rendered":"<p>Key Points:<\/p>\n<ul>\n<li>Sudden cardiac death causes a fifth of all deaths in industrialized countries, but survival to hospital discharge remains low.<\/li>\n<li>Transfer to a specialized, cath-lab capable cardiac arrest center may expedite care of patients with an ischemic cause of arrest.<\/li>\n<li>This multicenter randomized trial compared transfer to a specialized cardiac arrest center with the nearest ED in patients with a resuscitated out-of-hospital cardiac arrest (OHCA). The primary endpoint was 30-day all-cause mortality.<\/li>\n<li>There were no differences in the primary endpoint of all-cause mortality between the two transportation strategies, nor any difference in the secondary endpoints of 3-month mortality and neurological outcome.<\/li>\n<\/ul>\n<p><!--more-->Sudden cardiac death causes 20% of all deaths in industrialized countries. While early bystander CPR and early defibrillation improve survival, only 1:10 patients experiencing an out-of-hospital cardiac arrest (OHCA) survive to leave hospital. In a breaking presentation at the 2023 ESC Congress today, <a href=\"https:\/\/clevelandcliniclondon.uk\/doctors\/749-prof-simon-redwood\">Dr. Simon Redwood<\/a> and his team presented \u201cExpedited Transfer to a Cardiac Arrest Centre for non-ST Elevation OHCA,\u201d or the ARREST study. These results were also simultaneously published in <a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(23)01351-X\/fulltext\">The Lancet<\/a>.<\/p>\n<p>The ARREST study (<a href=\"https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT03872960\">NCT03872960<\/a>) was a randomized, open label, multicenter trial (conducted across 22 hospitals in London, UK) of adult patients who were successfully resuscitated from an out-of-hospital cardiac arrest. Patients were then randomized to either be transported to their nearest ED or the nearest cath-lab capable Cardiac Arrest Center. Key exclusion criteria were the presence of STEMI, a DNR order, suspected pregnancy, or presumed non-cardiac cause. The primary endpoint was 30-day all-cause mortality.<\/p>\n<p>A total of 862 patients were enrolled, of whom 431 (50%) were randomly assigned to a cardiac arrest center and 431 (50%) to standard of care. After some participants were withdrawn, 411 and 412 respectively were included in the primary analysis. The mean age was 63, and 32% were women. Half of the patients had symptoms preceding their arrest, and 55% had a shockable rhythm. Expectedly, there was a longer duration of time from arrest to hospital arrival in the cardiac arrest center group (84 mins vs 77 mins). There were no differences in the primary endpoint of all-cause mortality at 30 days, with a 63% mortality in each group (RR 1.00, 95% CI 0.90-1.11, p=0.96). There were also no significant differences in death at 3 months (65% in the cardiac arrest center group and 64% in the standard care group) or neurological outcome between groups. On subgroup analysis, there was interaction with age (p for interaction=0.0029); patients age &lt;57 had reduced 30-day all-cause mortality in the cardiac arrest center group (RR 0.76, 95% CI 0.60-0.97) whereas patients age 57-71 had increased all-cause mortality (RR 1.28, 95% CI 1.05-1.56).<\/p>\n<p>When discussing the clinical implications of the study at the ESC Congress press conference, Dr. Redwood stated: \u201cThis study does not support transportation of cardiac arrest patients directly to a cardiac arrest center in London\u2026.they should go to their nearest ED\u2026.these results may allow better allocation of resources elsewhere.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: Sudden cardiac death causes a fifth of all deaths in industrialized countries, but survival to hospital discharge remains low. Transfer to a specialized, cath-lab capable cardiac arrest center may expedite care of patients with an ischemic cause of arrest. This multicenter randomized trial compared transfer to a specialized cardiac arrest center with the [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":138041,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[513,881,8],"tags":[45,882,47,185],"ppma_author":[1029],"class_list":{"0":"post-138040","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-cardiac-arrest","8":"category-esc-2023","9":"category-news","10":"tag-conference","11":"tag-esc-2023","12":"tag-featured","13":"tag-news","14":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138040","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138040"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138040\/revisions"}],"predecessor-version":[{"id":138042,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138040\/revisions\/138042"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138041"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138040"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138040"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138040"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138040"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}