Simpson Rupert F G, Johnson Thomas, Rees Paul, Glover Guy, Sajjad Uzma, Fawaz Samer, Khan Sarosh, Beadle Emma, Perilla Daryl, Maccaroni Maria, Cook Christopher, Mion Marco, Xue Qiang, Jagathesan Rohan, Clesham Gerald J, Quinn Tom, Vopelius-Feldt Johannes Von, Gallagher Sean, Mozid Abdul, Gudde Ellie, Smith Carl, Warwick Pammi, Abell Tom, Durge Neal, Karamasis Grigoris V, Curzen Nick, Davies John R, Pareek Nilesh, Keeble Thomas R
Essex Cardiothoracic Centre, MSE Trust, Basildon, Essex, UK; Anglia Ruskin School of Medicine & MTRC, ARU, Chelmsford, Essex, UK.
Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, UK.
Resuscitation. 2025 Feb;207:110491. doi: 10.1016/j.resuscitation.2025.110491. Epub 2025 Jan 4.
Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.
This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.
Of 330 patients (mean age 67.5 ± 13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98-1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95-1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05-2.13) p = 0.02 and in those with a MIRACLE score ≤ 5 [(63%% vs 38%, RR 0.59 (95% CI 0.61-0.86) p = 0.005].
The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE score, to a dedicated CAC may improve survival.
指南建议将非创伤性院外心脏骤停（OHCA）患者转运至心脏骤停中心（CAC）。我们假设：（a）基于OHCA初始表现节律的院前转运算法是可行的；（b）该算法将显示出生存优势。
这项观察性试点研究纳入了2022年4月至2023年4月期间英国埃塞克斯郡所有因疑似心脏病因导致OHCA的连续患者。在最初的6个月里，OHCA患者按常规护理进行转运。在接下来的6个月里，STEMI或初始可电击心律的连续OHCA患者被直接转运至CAC，初始不可电击心律且无STEMI的患者继续被送往最近的急诊科（BCIS方案）。主要结局是30天时任何原因导致的死亡。次要结局是伴有良好神经功能结局的生存。
在330例患者（平均年龄67.5±13.1岁，66%为男性）中，162例患者在常规护理组，168例在BCIS转运组。算法实施与30天全因死亡率在数值上较低相关[（81%对73%，RR 1.10（95%CI 0.98 - 1.24），p = 0.10]，且在数值上伴有良好神经功能结局的30天生存率较高相关[15%对19%，RR 1.05（0.95 - 1.15），p = 0.38]。事后分析显示，BCIS转运算法与初始可电击心律患者的30天死亡率较低相关[（6
