A randomized trial of expedited intra-arrest transfer versus more extended on-scene resuscitation for refractory out of hospital cardiac arrest: Rationale and design of the EVIDENCE trial - 07/12/23
on behalf of the
EVIDENCE Investigators
ABSTRACT |
Background |
Refractory Out of Hospital Cardiac Arrest (r-OHCA) is common and the benefit versus harm of intra-arrest transport of patients to hospital is not clear.
Objective |
To assess the rate of survival to hospital discharge in adult patients with r-OHCA, initial rhythm pulseless ventricular tachycardia (VT)/ventricular fibrillation (VF) or Pulseless Electrical Activity (PEA) treated with 1 of 2 locally accepted standards of care:1 expedited transport from scene; or2 ongoing advanced life support (ALS) resuscitation on-scene.
Hypothesis |
We hypothesize that expedited transport from scene in r-OHCA improves survival with favorable neurological status/outcome.
Methods/Design |
Phase III, multi-center, partially blinded, prospective, intention-to-treat, safety and efficacy clinical trial with contemporaneous registry of patient ineligible for the clinical trial. Eligible patients for inclusion are adults with witnessed r-OHCA; estimated age 18 to 70, assumed medical cause with immediate bystander cardiopulmonary resuscitation (CPR); initial rhythm of VF/pulseless VT, or PEA; no return of spontaneous circulation following 3 shocks and/or 15 minutes of professional on-scene resuscitation; with mechanical CPR available. Two hundred patients will be randomized in a 1:1 ratio to either expedited transport from scene or ongoing ALS at the scene of cardiac arrest.
Setting |
Two urban regions in NSW Australia.
Outcomes |
Primary: survival to hospital discharge with cerebral performance category (CPC) 1 or 2. Secondary: safety, survival, prognostic factors, use of ECMO supported CPR and functional assessment at hospital discharge and 4 weeks and 6 months, quality of life, healthcare use and cost-effectiveness.
Conclusions |
The EVIDENCE trial will determine the potential risks and benefits of an expedited transport from scene of cardiac arrest.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : AED, ALS, AR-DRGs, ARR, CCL, CEACs, CHeReL, CPC, CPR, ECG, ECPR, ED, EMS, EQ-5D-5L, ETCO2, hpCPR, ICU, IDSMB, ILCOR, MCPR, MOCA, NNT, NSW, OHCA, PAPA, PCI, PEA, PROCAT, QALYs, REDCap, r-OHCA, ROSC, TRGS, VAS, VF, VT
Mappa
| The trial is registered at the Australian Clinical Trial Registry (ACTRN12621000668808). |
Vol 267
P. 22-32 - Gennaio 2024 Ritorno al numero
Articolo precedente
- Comparison of tirzepatide and dulaglutide on major adverse cardiovascular events in participants with type 2 diabetes and atherosclerotic cardiovascular disease: SURPASS‐CVOT design and baseline characteristics
- Stephen J. Nicholls, Deepak L Bhatt, John B Buse, Stefano Del Prato, Steven E Kahn, A Michael Lincoff, Darren K McGuire, Michael A Nauck, Steven E Nissen, Naveed Sattar, Bernard Zinman, Sophia Zoungas, Jan Basile, Amy Bartee, Debra Miller, Hiroshi Nishiyama, Imre Pavo, Govinda Weerakkody, Russell J Wiese, David D'Alessio, SURPASS-CVOT investigators
- Cardiovascular impact of near complete estrogen deprivation in premenopausal women with breast cancer: The CROWN study
- Alexandra Thomas, Nathaniel S. O'Connell, Emily Douglas, Sarah Hatcher, Carolyn J. Park, Susan Dent, Katherine Ansley, Igor Klem, Rani Bansal, Kelly Westbrook, W. Gregory Hundley, Wendy Bottinor, Mary Helen Hackney, Karl M. Richardson, Sherona R. Sirkisoon, Ralph B. D'Agostino, Jennifer H. Jordan
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?