Out of hospital cardiac arrest (OHCA) is the leading cause of sudden death in adults. This project will test the efficacy, replicability and value of an expedited bundle of care for OHCA and inform scalability of this strategy a model of care for OHCA in NSW.
What is the issue for NSW?
During OHCA, a patient’s heart suddenly stops beating effectively in a non-hospital environment. Each year NSW Ambulance responds to over 8,000 OHCAs. Of the >3,000 resuscitations attempted only 12% survive to hospital discharge.
The feasibility of a bundle of care for OHCA patients of: expedited transfer from scene, mechanical CPR (MCPR), extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) with subsequent immediate coronary angiography in carefully selected patients has produced excellent results. Rigorous assessment of the cost, scalability, efficacy, replicability and model of MCPR and ECPR is required to identify appropriate, evidence-based models of care.
Moreover, the optimal distribution of hospitals providing ECPR is not known, therefore more data is needed on efficacy and cost of MCPR and ECPR versus standard care.
ECPR is a time-critical procedure. Not all patients are currently within geographical range of an ECPR hospital. Several non-ECPR hospitals offer coronary angiography or patients thus the expedited bundle of care of MCPR and coronary angiography will also be investigated.
What does the research aim to do and how?
To test the efficacy, replicability and cost of the expedited model of care with MCPR, ECPR and coronary angiography by completing:
- A world first randomised clinical trial comparing expedited transfer versus standard non-expedited OHCA care.
- A robust health economics analysis including systems level and budget impacts.
- Cost existing model of care using the linked Population Health Risks and Outcomes Register.
- The first spatial modelling of cardiac arrests in NSW, using OHCA registry GPS data for optimum distribution of ECPR hospitals to capture >80%,>90% and >99% of eligible arrests.
This study will inform a new model of care and its expansion within Sydney and greater NSW.
The project will assess:
- Survival with favourable neurological outcomes post OHCA.
- The cost per patient treated and per survivor of the intervention versus conventional care.
- The budget impact for NSW Health in providing this care.