Transfer to a specialized cardiac arrest center did not improve survival or neurologic outcomes in patients with resuscitated non-hospital cardiac arrest.

Patients with resuscitated out-of-hospital cardiac arrest (OHCA) without ST elevation did not benefit from immediate transfer to a specialized cardiac arrest center compared with a transfer to the nearest ED in terms of survival or neurologic outcomes. These were the main results of the ARREST trial, presented at ESC Congress 2023.

“There are regional differences in cardiac arrest survival due to variations in infrastructure, resources, and personnel,” Tiffany Patterson, PhD, pointed out. “The standard of care for patients with resuscitated OHCA is to transfer them to the nearest ED. However, post-arrest care may best be delivered at a specialized center.”

The ARREST trial assessed whether transferring patients with resuscitated non-ST elevated OHCA to a specialized center improves their chance of survival compared with delivery to the nearest ED. The study included 32 EDs and seven specialized cardiac arrest centers in London. Ambulance paramedics randomly assigned pre-hospital patients (n=862) 1:1 to either a transfer to the nearest ED or a transfer to a specialized care center. The primary outcome was 30-day all-cause mortality.

At 30 days, no differences were observed between the standard-of-care group and the cardiac-arrest-center 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 neurologic outcomes at discharge, confirmed that transfer to a specialized cardiac arrest center did not result in significant health benefits for patients.

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