The impact of direct pre-hospital conveyance of patients with out-of-hospital cardiac arrest and a shockable rhythm to a regional cardiac arrest centre

Abstract

Background and aims: guidelines recommend that survivors of out-of-hospital cardiac arrest (OHCA) be transported to a cardiac arrest centre (CAC), though supporting evidence remains limited. This study evaluated whether implementation of the BCIS algorithm, based on initial rhythm, improves survival outcomes.

Methods: this observational, multicentre study compared consecutive OHCA cases before and after algorithm implementation across Essex. In the Standard Care phase (April–September 2022), CAC transfer was based on clinical discretion, typically for STEMI or suspected cardiac cause. In the BCIS Protocol phase (October 2022–August 2025), all patients with an initial shockable rhythm were conveyed directly to CAC, as were those with STEMI on pre-arrest or post-ROSC ECG irrespective of initial rhythm (standard care); others were taken to district general hospitals (DGH) or discussed with CAC.

The primary outcome was 30-day all-cause mortality; the secondary outcome was survival with favourable neurological status (CPC 1-2).

Results: among 850 patients (mean age 66.5±13.7 years, 69% male), 162 received standard care and 688 were managed under the BCIS protocol. Initial shockable rhythm conveyance adherence to CAC was seen in 84% cases, resulting in 40% absolute increase in the proportion of patients with an initial shockable rhythm being transported directly to CAC (44% in the standard care group vs 84% in the BCIS group).

Algorithm implementation was associated with significantly reduced 30-day mortality (81% vs 67%; p<0.001) and increased survival with favourable neurological outcome (16% vs 30%; p<0.001). Improvements were most evident in patients with shockable rhythms (62% vs 42%; p=0.001). No difference was observed for non-shockable rhythms (94% vs 93%; p=0.81).

Conclusions: implementation of the BCIS conveyance algorithm improves 30-day survival and neurological outcomes in OHCA patients with shockable rhythms when transported directly to a CAC.

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Identifiers

ORCID for Nick Curzen: orcid.org/0000-0001-9651-7829

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