Specialty Care for Cardiac Arrest

(SPARC Trial)

Overseen By Sara DiFiore-Sprouse

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Disqualifiers: Advanced directives, Dependent status, Traumatic arrest, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: Up to 90 days

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines whether people resuscitated from a cardiac arrest outside of a hospital fare better when treated at a specialized center. It compares two groups: one transferred to a specialty hospital and the other receiving care at the nearest suitable hospital. The goal is to determine which type of care aids better recovery after 90 days. Anyone who has survived an out-of-hospital cardiac arrest and is currently in the emergency room may be eligible. As an unphased trial, this study provides a unique opportunity to contribute to important research that could enhance care for future cardiac arrest patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems participants will receive all usual medical care, so you may be able to continue your medications, but it's best to confirm with the trial coordinators.

What prior data suggests that this protocol is safe for cardiac arrest patients?

Research has shown that patients treated at specialized centers after experiencing a cardiac arrest outside the hospital tend to have better outcomes. These centers can significantly reduce the risk of death within the first day, suggesting that their care is safe and potentially more effective than standard care.

In one study, the 30-day survival rate was similar for patients treated at a cardiac arrest center and those who received standard care, with 63% of patients in both groups not surviving. This finding suggests that transferring to a specialty center does not increase the risk of negative outcomes. Overall, the evidence supports that specialized care for cardiac arrest is safe and well-tolerated. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the transfer to specialty care for cardiac arrest because it aims to provide rapid transport to specialized hospitals equipped with advanced cardiac care capabilities. Unlike standard treatment where patients might be kept at the first available hospital or transferred to the nearest appropriate facility, this approach ensures that patients receive immediate, high-level specialized care that might not be available at all hospitals. The hope is that this method could improve outcomes by leveraging the expertise and equipment found in specialty centers, potentially leading to better recovery rates for cardiac arrest patients.

What evidence suggests that transferring to specialty care is effective for cardiac arrest recovery?

Research has shown that people who survive a cardiac arrest outside of a hospital recover better when treated at specialized centers. In this trial, participants in the "Transfer to specialty care" arm will undergo immediate interfacility transport and receive hospital treatment at a specialty care hospital. These centers focus on specific treatments and have expert staff. For instance, one study found no major difference in death rates within 30 days between patients sent to these centers and those who weren't, suggesting benefits in other areas like regaining abilities. Another study highlighted that these centers have advanced resources that could aid recovery. Overall, receiving care at a specialized center might improve recovery after a cardiac arrest. ^{1 2 4 5 6}

Who Is on the Research Team?

Jonathan Elmer, MD, MS

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

Adults who've had a cardiac arrest outside of the hospital and were resuscitated with a stable pulse in the emergency department can join. They must be treated at one of the participating hospitals and be 18 years or older.

Inclusion Criteria

I am 18 years old or older.

I experienced a cardiac arrest outside of a hospital.

Treated at one of participating hospital emergency departments

Exclusion Criteria

Known to have opted-out from the SPARC trial

My cardiac arrest was caused by a physical injury.

Known prior advanced directives or decision to limit critical care

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either specialty care at a high-volume center or usual care at the closest appropriate hospital

Up to 90 days

Follow-up

Participants are monitored for recovery of function using the Modified Rankin Scale 90 days after cardiac arrest

90 days

1 visit (in-person or virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Transfer to specialty care

Trial Overview The trial is testing if transferring patients to specialized centers after a cardiac arrest improves their recovery over 90 days, compared to usual care at the closest appropriate hospital.

How Is the Trial Designed?

Group I: Transfer to specialty care Experimental Treatment 1 Intervention

Participants randomized to receive specialty care will undergo immediate interfacility transport to and hospital treatment at the specialty care hospital

Group II: Usual care Active Control 1 Intervention

Participants randomized to the usual care arm will be hospitalized at the first hospital or transferred to the closest appropriate hospital

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10530609/

Comparing strategies for prehospital transport to specialty ... Outcomes are better when patients resuscitated from out-of-hospital cardiac arrest (OHCA) are treated at specialty centers.

2. ahajournals.org ahajournals.org/doi/10.1161/CIR.0000000000001282

Management of Patients With Cardiac Arrest Requiring ... Comparing strategies for prehospital transport to specialty care after cardiac arrest. Resuscitation. 2023;191:109943. doi: 10.1016/j ...

3. thelancet.com thelancet.com/journals/lancet/article/PIIS0140-6736(23)01351-X/fulltext

Expedited transfer to a cardiac arrest centre for non-ST ... The primary endpoint of 30-day mortality occurred in 258 (63%) of 411 participants in the cardiac arrest centre group and in 258 (63%) of 412 in ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT07002294

The Effect of SPecialty cAre on Recovery From Cardiac ... This randomized trial will compare outcomes for patients assigned to care at the specialty center versus other centers and will leverage the heterogeneity of ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S2666520425001833

The impact of additional special emergency medical ... Conclusions. The presence of additional EMS special units like field supervisors can improve outcomes of non-traumatic out-of-hospital cardiac arrest in a high- ...

6. annemergmed.com annemergmed.com/article/S0196-0644(18)30455-4/fulltext

Long-Term Outcomes of Out-of-Hospital Cardiac Arrest ... Cardiac arrest receiving center care is associated with a substantial mortality reduction in the first day after out-of-hospital cardiac arrest.