None listed
Conditions
Brief summary
Cardiac arrest is the most common cause of death in otherwise healthy adults. Each year in NSW Ambulance responds to over 8,000 Out of Hospital Cardiac Arrests (OHCA). Of the approximately 3,000 arrests where resuscitation is attempted, only 12% survive to hospital discharge overall. Mechanical cardiopulmonary resuscitation (MCPR) devices deliver uninterrupted effective manual chest compressions throughout patient extrication and transfer in a moving ambulance (currently NSW Paramedics cannot provide ongoing chest compressions in these scenarios). This allows for emergent transportation of patients in cardiac arrest to hospital and either directly for coronary angiography or full cardio-respiratory support with Extracorporeal Membrane Oxygenation (ECMO). ECMO-CPR (ECPR) restores perfusion/circulation in a patient by a machine and allows doctors time to investigate/treat the cause of the cardiac arrest (i.e. myocardial infarction and coronary angioplasty/stenting). A cardiac arrest treatment with a bundle of care of expedited transfer from OHCA scene to hospital, MCPR and coronary angiography and/or ECPR may be of benefit above traditional more extended on scene resuscitation.
Interventions
Expedited transfer (after 15 minutes of professional paramedic resuscitation) with Mechanical Cardiopulmonary Resuscitation (MCPR) and emergent coronary angiography with or without Extracorporeal Membrane Oxygenation CPR (ECPR). Intensive care paramedics will deliver the intervention and participants will be randomised on scene using the REDCap application. A short survey will be completed and patients will be randomised (1:1) to the control arm (standard protocols and extended on scene resuscit
Expedited transfer (after 15 minutes of professional paramedic resuscitation) with Mechanical Cardiopulmonary Resuscitation (MCPR) and emergent coronary angiography with or without Extracorporeal Membrane Oxygenation CPR (ECPR). Intensive care paramedics will deliver the intervention and participants will be randomised on scene using the REDCap application. A short survey will be completed and patients will be randomised (1:1) to the control arm (standard protocols and extended on scene resuscitation) or the expedited arm (aim to transport participants off scene within 15 minutes of commencement of CPR). The duration of on site resuscitation and transport from scene is recorded in the NSW Ambulance case sheet, and will be transcribed into the secure REDCap database. Duration of the study is 2.5 years.
Sponsors
University of Sydney/NHMRC CTC
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
1. Non-traumatic out of hospital cardiac with suspected medical cause Note: Only non-traumatic cardiac arrests will be included, traumatic cardiac arrests such as blunt traumatic body injury from any cause e.g. motor vehicle collision will not be included. Drownings will be included providing they meet all other inclusion criteria. 2. MCPR present and all of the following a. Estimated age 18-70 years. b. Witnessed OHCA. c. Initial rhythm VT/VF or automatic external defibrillator (AED) shock delivered or PEA arrest. d. Bystander CPR started within <5 minutes and ongoing on ambulance arrival with no history suggestive of a prolonged period without CPR.
Exclusion criteria
1. A traumatic cardiac arrest including blunt traumatic body injury from any cause e.g. hanging, motor vehicle accident. 2. Asystole as first rhythm. 3. Terminal illness (including end-stage heart, lung disease or malignancy). 4. Current advance care directive limiting treatment. 5. Advanced cognitive impairment e.g. dementia.
Outcome results
None listed