ACCESS Trial (Proposed Trial)

Please share your opinions about whether researchers should conduct trial.

Ischemic heart disease (blocked arteries in the heart) is the underlying cause in many patients who suffer cardiac arrest.  (Cardiac arrest is a situation where the heart stops suddenly and the patient collapses.)  In particular, patients who require an electrical rescue shock to start their heart are often suffering from a blocked artery in the heart (a heart attack).  Usual treatment for patients whom paramedics resuscitate from cardiac arrest involves going to the emergency department (ED) and then intensive care unit (ICU) for evaluation.  In patients where evaluation suggests a blocked artery in the heart, cardiologists are then consulted to consider coronary angiography (a cardiac catheterization).  

Coronary angiography (cardiac catheterization) is a procedure in which cardiologists pass catheters into an artery (through the groin or the arm) and into the heart.  Dye is injected to visualize whether arteries in the heart are blocked or narrowed.  Balloons, stents, or other devices can then be used to open the artery.   This procedure is the preferred treatment for heart attacks.  It is often performed emergently after cardiac arrest, but some patients do not undergo catheterization until several hours or days later.

This trial will test whether IMMEDIATE activation of transport for cardiac catheterization will improve survival with good neurological outcome. Investigators believe that earlier treatment with catheterization might be superior for many patients.

Adult patients who are resuscitated from cardiac arrest will be randomly assigned (like flipping a coin) to either go immediately to cardiac catheterization (and treatment as needed) or to first undergo evaluation in the ED and ICU.  People in the second ED/ICU group may go to cardiac catheterization later if any of the treating physicians think that is best.  In both strategies, teams will provide all the best possible care for these patients.

Because the early activation of the cardiology team for cardiac catheterization must happen when the hospital first hears about a patient, subjects for this trial will be enrolled with exception from informed consent.  Patients after cardiac arrest are usually unconscious and unable to speak for themselves.  Therefore, investigators will tell their families or legally authorized representatives about which treatment strategy was selected as soon as feasible.