The impact of direct pre-hospital conveyance of patients with out-of-hospital cardiac arrest and a shockable rhythm to a regional cardiac arrest centre

BACKGROUND AND AIMS: Guidelines recommend that survivors of out-of-hospital cardiac arrest (OHCA) be transported to a cardiac arrest centre (CAC), though supporting evidence remains limited. This study evaluated whether implementation of the BCIS algorithm, based on initial rhythm, improves survival outcomes. METHODS: This observational, multicentre study compared consecutive OHCA cases before and after algorithm implementation across Essex. In the Standard Care phase (April-September 2022), CAC transfer was based on clinical discretion, typically for STEMI or suspected cardiac cause. In the BCIS Protocol phase (October 2022-August 2025), all patients with an initial shockable rhythm were conveyed directly to CAC, as were those with STEMI on pre-arrest or post-ROSC ECG irrespective of initial rhythm (standard care); others were taken to district general hospitals (DGH) or discussed with CAC.The primary outcome was 30-day all-cause mortality; the secondary outcome was survival with favourable neurological status (CPC 1-2). RESULTS: Among 850 patients (mean age 66.5±13.7 years, 69% male), 162 received standard care and 688 were managed under the BCIS protocol. Initial shockable rhythm conveyance adherence to CAC was seen in 84% cases, resulting in 40% absolute increase in the proportion of patients with an initial shockable rhythm being transported directly to CAC (44% in the standard care group vs 84% in the BCIS group).Algorithm implementation was associated with significantly reduced 30-day mortality (81% vs 67%; p