Science
Ambulances should take cardiac arrest patients to closest emergency department
People who have an out-of-hospital cardiac arrest should be taken straight to their nearest emergency department, according to research we’ve funded presented today at the European Society of Cardiology Congress in Amsterdam and published in The Lancet.
The trial, which involved the London Ambulance Service and every hospital in London, found no difference in 30-day survival for out-of-hospital cardiac arrest (OHCA) patients who were taken by ambulance to a specialist cardiac arrest centre compared with those delivered to the geographically closest emergency department.
The study also found no overall difference in brain and nerve function at discharge and at three months between the specialist centre and emergency department groups.
Biggest test to date
There are more than 30,000 OHCAs in the UK each year. Despite increased public awareness of the importance of early CPR and defibrillation, and advances in hospital treatment, the UK survival rate is less than one in 10.
Specialist cardiac arrest centres provide targeted critical care, imaging services and predictions of brain recovery beyond what is available in conventional emergency departments. Data from previous studies had suggested that ambulance delivery of OHCA patients to specialist cardiac arrest centres improves survival.
The ARREST trial was the biggest test of this theory to date involving 862 patients across London between 2018 and 2022. Everyone involved had been resuscitated following an out-of-hospital cardiac arrest, but did not appear to be having a heart attack. Half were randomly assigned by paramedics to be transferred to a cardiac arrest centre and half to the nearest emergency department, the current standard of care.
Exactly the same number of patients in each group – 258 – had died by 30 days. There was also no difference between the two groups in death rates after three months.
“Answers an important question”
Dr Tiffany Patterson, a consultant cardiologist at Guy's and St Thomas' NHS Foundation Trust in London, said: “This study does not support transportation of all patients to a cardiac arrest centre following resuscitated cardiac arrest within this healthcare setting. Cardiac arrest centres are heavily resourced hospitals. If delivering these patients to such centres 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, ST-elevation myocardial infarction and acute aortic dissection – that requires high-dependency beds and the specialist input provided by these centres.”
Professor Sir Nilesh Samani, our Medical Director, said: “There are more than 30,000 out of hospital cardiac arrests in the UK each year, but the survival rate remains stubbornly low at less than one in ten.
“The question of whether to take OHCA patients who are successfully resuscitated directly to a heart attack centre rather than to their nearest ED has long been debated. This first-of-its-kind trial answers this important practical question and suggests that it does not make a difference to patients surviving longer-term.
“This study was carried out in London, so whether the results would be any different in other settings remains to be studied.”