Condition category
Circulatory System
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status

Plain English Summary

Background and study aims
Out-of-hospital cardiac arrest (OHCA) is the leading cause of death in Europe and the United States. In most cases this is due to a blockage in a coronary artery that supplies blood to the heart (myocardial infarction). This study aims to find out whether a strategy of early transfer to a specialist centre equipped at dealing with OHCA with access to facilities to treat the cause of the arrest, including unblocking of the arteries, will improve survival compared to current standard treatment.

Who can participate?
Men and women aged over 18 who have an out-of-hospital cardiac arrest

What does the study involve?
Patients are randomly allocated to receive either the intervention or the current standard of care. Patients in the intervention group are treated with an immediate transfer to hospital with specialist services to manage a patient with cardiac arrest - this hospital is able to immediately treat a heart attack if this is found to be the cause of the cardiac arrest. Patients allocated to the standard of care group receive the current best standard of care.

What are the possible benefits and risks of participating?
The possible benefits include improved survival. There is no financial benefit. If the participants survive the cardiac arrest there is a slight risk (less than 1%) of procedure-related complications. The risks of participating do not outweigh the risks of sudden cardiac death.

Where is the study run from?
The pilot study, which is performed in a small group of patients to see if a wider scale study is possible, was run from St Thomas' Hospital, London, UK and London Ambulance Service. The main study is expected to be performed in all the major cardiac arrest centres in London: St Thomas’ Hospital, Barts Health, Hammersmith Hospital, Royal Free Hospital, St George’s hospital, King’s College Hospital, Harefield Hospital, London Ambulance Service

When is study starting and how long is it expected to run for?
The pilot study started in November 2014 and completed recruitment in February 2016. The main study will run from January 2017 until October 2022.

Who is funding the study?
Funding for the main study is still pending. The pilot study was supported by Guy’s and St. Thomas’ Charitable Foundation and Zoll Medical Corporation (unrestricted educational grant).

Who is the main contact?
1. Prof. Simon Redwood (
2. Dr Tiffany Patterson (

Trial website

Contact information



Primary contact

Prof Simon Redwood


Contact details

Cardiovascular Division
Rayne Institute
6th Floor
East Wing
St Thomas' Hospital
Westminster Bridge Road
United Kingdom



Additional contact

Mr Alexander Perkins


Contact details

Department of Medical Statistics
London School of Hygiene and Tropical Medicine
Keppel Street
United Kingdom
+44 020 7927 2723

Additional identifiers

EudraCT number number


Protocol/serial number

1.0, IRAS 125842

Study information

Scientific title

A Randomised tRial of Expedited transfer to a cardiac arrest centre for non- ST elevation out of hospital cardiac arrest (ARREST): a randomised controlled trial



Study hypothesis

Current hypothesis as of 27/09/2016:
The aim is definitively determine the best post-resuscitation care pathway for patients without ST elevation on the post resuscitation ECG. We propose that changes to emergency management comprising expedited delivery to a cardiac arrest centre (CAC) with organised post-cardiac arrest care including immediate access to reperfusion therapy will reduce mortality in patients without STE compared to the current standard of care.

Previous hypothesis:
A strategy of immediate coronary angiography after ventricular fibrillation out-of-hospital cardiac arrest confers a survival benefit compared to current standard of care.

Ethics approval

South East NRES Committee London, 02/01/2014, ref: 13/LO/1508

Study design

Open randomised controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet


Cardiac arrest


Current interventions as of 27/09/2016:
1. The intervention arm consists of activation of a pre-hospital triaging system (currently routinely in place for post-arrest patients with evidence of ST elevation on the ECG) with pre-alert of the cardiac arrest centre and strategic delivery of the patient to the catheter laboratory (24 hours a day, 7 days a week). They will receive definitive post-resuscitation care: intubation and ventilation, where necessary, targeted temperature management and goal-directed therapies including evaluation and identification of underlying cause of arrest with access to immediate reperfusion if necessary. Prognostication will occur no earlier than 72 hours post-cardiac arrest, this protocolised prognostication will ensure premature withdrawal of life-sustaining treatment is prevented.
2. The control arm receives standard of care

Previous interventions:
Randomisation 1:1 into two arms through telephone randomisation:
1. Intervention arm: expedited transfer to hospital, direct to heart attack centre, immediate coronary angiography +/- percutaneous coronary intervention (PCI)
2. Control arm: standard of care
Follow up: All-cause mortality at 30 days, 6 months and 1 year (mortality tracking via central NHS database).
Study Classification (Endpoint): Safety/Efficacy

Intervention type



Drug names

Primary outcome measure

All-cause mortality at 30 days

Secondary outcome measures

Current secondary outcome measures as of 27/09/2016:
1. Neurological status at discharge (capped at 30 days)
2. Neurological status at 3 months
3. All-cause mortality at 3, 6 and 12 months
4. The composite of in-hospital major adverse cerebrovascular or cardiovascular events (MACCE): death, re-infarction, stroke, further revascularisation, bleeding and vascular complications (capped at 30 days)
5. Quality of life (EQ-5D-5L) at 12 months

Previous secondary outcome measures:
1. All-cause mortality at 6 months and 1 year
2. Neurological status at hospital discharge, capped at 30 days
3. Major adverse cardiovascular events:
3.1. Acute myocardial infarction
3.2. Need for repeat revascularization: PCI or coronary artery bypass grafting (CABG)
3.3. Major bleeding: procedure-related complication (requiring surgery or drop in Hb >3g/dL)

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

Current participant inclusion criteria as of 14/02/2020:
1. Out-of-hospital cardiac arrest (OHCA)
2. Return of spontaneous circulation (ROSC)
3. Aged 18 or over (known or presumed)

Previous inclusion criteria as of 27/09/2016:
1. Witnessed out-of-hospital cardiac arrest
2. Return of spontaneous circulation and 12-lead electrocardiogram
3. Age 18 or over (known or presumed)
4. No obvious non-cardiac cause (trauma, drowning, suicide, drug overdose)

Previous inclusion criteria:
1. Witnessed out-of-hospital cardiac arrest
2. Absence of non-cardiac cause (trauma, drowning, intoxication)
3. Presenting rhythm: pulseless VT or VF

Participant type


Age group




Target number of participants

40 (pilot); 860 (main trial)

Participant exclusion criteria

Current participant exclusion criteria as of 14/02/2020:
1. Criteria for ST-elevation myocardial infarction on 12-Lead electrocardiogram (ECG)
2. Do Not Attempt Resuscitation (DNAR) Order
3. Cardiac arrest suffered after care pathway set and patient en route
4. Suspected pregnancy
5. Presumed non-cardiac cause (for example; trauma, drowning, suicide, drug overdose)
6. Presumed significant trauma/injury

Previous exclusion criteria as of 27/09/2016:
1. Criteria for ST-elevation myocardial infarction on 12-lead electrocardiogram
2. Do Not Attempt Resuscitation Order
3. Suspected pregnancy

Previous exclusion criteria:
1. ST-elevation myocardial infarction (STEMI) on 12-lead ECG in presence of return of spontaneous circulation (ROSC)
2. Pulseless electrical activity (PEA) or Asystole (non-shockable) as the only documented rhythm
3. Do Not Attempt Resuscitation Order (DNAR)
4. Suspected pregnancy

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

St Thomas’ Hospital
United Kingdom

Trial participating centre

Barts Health
E1 1RD
United Kingdom

Trial participating centre

Hammersmith Hospital
W12 0HS
United Kingdom

Trial participating centre

Royal Free Hospital
United Kingdom

Trial participating centre

St George’s Hospital
SW17 0QT
United Kingdom

Trial participating centre

King’s College Hospital
United Kingdom

Trial participating centre

Harefield Hospital
United Kingdom

Trial participating centre

London Ambulance Service
United Kingdom

Sponsor information


Guy's and St Thomas' NHS Foundation Trust

Sponsor details

c/o Mrs Karen Ignatian
R&D Department
16th Floor
Guy's Tower
United Kingdom

Sponsor type

Hospital/treatment centre



Funder type


Funder name

Guy's and St Thomas' Charity - Interventional Research Fund

Alternative name(s)

Funding Body Type

private sector organisation

Funding Body Subtype

other non-profit


United Kingdom

Funder name

Zoll Medical Corporation (unrestricted educational grant)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

1. Results of the trial pilot: submitted for peer review
2. Trial protocol: on commencing main trial

Intention to publish date


Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

1. 2018 protocol in:
2. 2017 pilot study in (added 17/02/2020)

Publication citations

Additional files

Editorial Notes

04/05/2020: Due to current public health guidance, recruitment for this study has been paused. 17/02/2020: The following changes have been made: 1. Publication reference added. 2. The IRAS number has been added. 3. The public contact has been added. 14/02/2020: The following changes have been made: 1. The recruitment end date has been changed from 01/01/2021 to 30/04/2022. 2. The overall trial end date has been changed from 01/01/2020 to 31/10/2020. 3. The intention to publish date has been changed from 01/01/2022 to 30/04/2022. 4. The trial website has been added. 5. The participant inclusion criteria have been updated. 6. The participant exclusion criteria have been updated. 7. The plain English summary has been updated to reflect the changes above. 16/08/2019: number added. 10/08/2018: Publication reference added. 27/09/2016: The following changes were made to the trial record: 1. The title was changed from 'Immediate coronARy angioRraphy aftEr ventricular fibrillation out-of hospital cardiac arreST' to 'A Randomised tRial of Expedited transfer to a cardiac arrest centre for non- ST elevation out of hospital cardiac arrest' 2. The overall trial end date was changed from 31/03/2017 to 01/01/2021. 3. The target number of participants was changed from '350' to '40 (pilot); 860 (main trial)' 27/10/2014: The overall trial start date was changed from 01/04/2014 to 01/11/2014.