People whose hearts have stopped should be taken to their nearest emergency department rather than a specialist cardiac arrest centre, a study suggests.
A randomised trial carried out in the UK found no difference in the survival of resuscitated patients taken by ambulance to the different hospitals.
However, researchers concluded those who suffer a heart attack, when an artery becomes blocked, rather than cardiac arrest, when the heart has stopped pumping blood, should still be taken to the specialist centres, which provide targeted critical care beyond what is available in conventional emergency departments.
The results, presented to the European Society of Cardiology (ESC) Congress in Amsterdam, open the door to suggestions medical resources could be better allocated elsewhere.
Study author Dr Tiffany Patterson of London’s Guy’s and St Thomas’ NHS Foundation Trust said: “This study does not support transportation of all patients to a cardiac arrest centre following resuscitated cardiac arrest.
“Cardiac arrest centres are heavily resourced hospitals.
“If delivering these patients to such centres to receive multiple interventions does not improve overall survival, then these resources are better allocated elsewhere.
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“Furthermore, if cardiac arrest patients are not taken to such hospitals, this frees up space for other emergency work that requires high-dependency beds and the specialist input provided by these centres.”
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Sudden cardiac arrest causes one in five deaths in industrialised countries.
Previous data suggested there was a better survival rate when treating patients at a specialist centre and there is a strong drive to do so internationally.
A randomised trial involving all hospitals in London carried out between January 2018 and December 2022 looked at the survival rates of 862 patients after 30 days.
Of those, 431 were randomly assigned by London Ambulance Service paramedics to be transferred to a cardiac arrest centre, while the other 431 remained in standard care.
There are 32 emergency departments in London, and seven cardiac arrest centres.
The study found exactly the same number of patients, 258 (63%), from both groups had died within 30 days.
Professor Simon Redwood, from Guy’s and St Thomas’ said the benefit of taking patients to an emergency department rather than to a specialist centre was likely to be even greater in rural areas where ambulance transfer times are longer.
“Patients are better off going to the nearest emergency department,” he said.
“If it was in a rural situation where perhaps the transfer times could be much longer to get to a cardiac arrest centre, I imagine that would make the results even worse for the cardiac arrest centre.”
Professor Sir Nilesh Samani, medical director of the British Heart Foundation, added: “There are more than 30,000 out-of-hospital cardiac arrests in the UK each year, but the survival rate remains stubbornly low at less than one in 10.
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“The question of whether taking out-of-hospital cardiac arrest patients who are successfully resuscitated directly to a heart attack centre rather than to their nearest emergency department has long been debated.
“This first-of-its-kind trial answers this important practical question and suggests that it does not make a difference to patients surviving longer term.”
