Written by Ketan Patel and Charles Worth
Spoon Feed
This review article discusses four randomized clinical trials (RCT) focusing on interventions for out-of-hospital-cardiac-arrest (OHCA) that were published in 2023, all of which showed negligible impact on survival for the interventions studied.
Minimal gains in OHCA care (and tortured acronyms)
- INCEPTION Trial – Early Initiation of Extracorporeal Life Support in Refractory OHCA
See separate Journal Feed dedicated to this study: INCEPTION. This multicenter randomized controlled trial comparing ECPR vs conventional CPR for refractory cardiac arrest showed no improvement in neurologically intact survival at 30 days. - TAME Trial – Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest
See separate Journal Feed dedicated to this study: TAME. In this OHCA patient population, targeted mild hypercapnia showed no significant favorable neurological outcomes at 6 months compared to normocapnia. - ARREST Trial – A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation OHCA
This was covered by JournalFeed in the Top Picks video series by Dr. Alblaihed. This RCT tested if transport of resuscitated OHCA patients without ST elevation after ROSC to a cardiac center would improve outcomes vs. transfer to the nearest emergency department. This was conducted in London at 35 hospitals, including 862 randomized patients. The time to arrive at the cardiac center was similar to the nearest emergency department (84min vs. 77min). Key findings were that the 30-day all-cause mortality was the same (63% vs 63%) as was the 3-month all-cause mortality (65% vs 64%) as well as survival with favorable neurologic outcomes (30% vs. 31%). - STEROHCA Trial – STERoid for Out-of-Hospital Cardiac Arrest
This RCT conducted in Denmark tested if administration of high-dose methylprednisolone (250mg IV bolus) to OHCA patients with ROSC could reduce inflammatory markers and reduce secondary neurological injury. 158 randomized patients were included. Baseline IL-6 values were similar, though the intervention group saw a reduction at 24 hours (2.1pg/mL vs. 29.8pg/mL, p < 0.0001), at 48 hours (5.7pg/mL vs. 10.1pg/mL), but not at 72 hours. This also did not lead to other improved brain injury biomarkers.
How will this change my practice?
Based on these RCTs in patients presenting with OHCA, ECPR, mild hypercapnia, and transport to a cardiac arrest center were not associated with improved outcomes and, therefore, will not be changing my practice at this time.
Peer Reviewed by Dr. Ketan Patel
Source
Top cardiac arrest randomised trials of 2023. Resuscitation. 2024 Mar;196:110133. doi: 10.1016/j.resuscitation.2024.110133. Epub 2024 Feb 3.
