ARREST
Trial question
What is the role of expedited transfer of patients with resuscitated out-of-hospital cardiac arrest without ST elevation to a cardiac arrest center?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
32.0% female
68.0% male
N = 822
822 patients (262 female, 560 male).
Inclusion criteria: adult patients with return of spontaneous circulation following out-of-hospital cardiac arrest without ST elevation.
Key exclusion criteria: presumed non-cardiac cause; pregnancy; STEMI; DNR order; no return of spontaneous circulation; return of circulation not sustained.
Interventions
N=412 cardiac arrest center (expedited delivery to cardiac catheter laboratory at cardiac arrest centers).
N=411 standard care (delivery to geographically closest emergency department).
Primary outcome
Death at day 30
63%
63%
63.0 %
47.3 %
31.5 %
15.8 %
0.0 %
Cardiac arrest
center
Standard
care
No significant
difference ↔
No significant difference in death at day 30 (63% vs. 63%; RR 1, 95% CI 0.9 to 1.11).
Secondary outcomes
No significant difference in death at 3 months (65% vs. 64%; RR 1.02, 95% CI 0.92 to 1.12).
No significant difference in favorable mRS score at discharge (32% vs. 32%; RR 1.01, 95% CI 0.92 to 1.11).
No significant difference in favorable mRS score at 3 months (30% vs. 31%; RR 1.01, 95% CI 0.92 to 1.11).
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In adult patients with return of spontaneous circulation following out-of-hospital cardiac arrest without ST elevation, cardiac arrest center was not superior to standard care with respect to death at day 30.
Reference
Tiffany Patterson, Gavin D Perkins, Alexander Perkins et al. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet. 2023 Oct 14;402(10410):1329-1337.
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