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27 August 2023

A&E just as effective as cardiac centres for heart attacks

Patients in cardiac arrest are not more likely to survive if they are taken to a specialist cardiac arrest centre compared to those delivered to the geographically closest A&E.

Ambulance in an emergency

The randomised trial presented today at the ESC Congress and published in The Lancet found no overall difference in neurological outcomes after discharge and three months later between the two groups.

Researchers advise patients should be delivered to the closest emergency department to free up resources for other emergency work.

Despite improvements in care, only one in 10 patients resuscitated from out-of-hospital cardiac arrest (OCHA) survive to be discharged from hospital. Cardiac arrest centres provide targeted critical care, acute cardiac care, radiology services and prediction of recovery after loss of consciousness beyond what is available in conventional emergency departments. Because of this, there has been a strong drive to treat OHCA in these specialist centres.

The ARREST trial, a randomised trial involving all hospitals in London, UK, investigated whether transfer of OHCA patients by the London Ambulance Service to a cardiac arrest centre reduces mortality compared with delivery to the closest emergency department.

862 patients were enrolled on the trial between 15 January 2018 and 1 December 2022, of whom 431 (50%) were randomly assigned by London Ambulance Service paramedics to transfer to a cardiac arrest centre and 431 (50%) to standard care.

258 (63%) of 411 patients in the cardiac arrest centre group and 258 (63%) of 412 patients in the standard care group did not survive after 30 days. The data also neurological outcomes were similar at hospital discharge and three months.

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.

Study author Dr. Tiffany Patterson, an NIHR Academic Clinical Lecturer at the School of Cardiovascular and Metabolic Medicine & Sciences

Dr Patterson added: "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.”

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Tiffany Patterson

NIHR Academic Clinical Lecturer