Pre-hospital care after return of spontaneous circulation: Are we achieving our targets?
I A Vos, F G Lucassen, B W J Bens...
https://pubmed.ncbi.nlm.nih.gov/39006133Actively Recruiting
Phase 2
Phase 3
Age: 18Years +
All Genders
ID07239908
Resuscitation Enhancement to Avoid Rearrest Through Evidence-based Strategies in Prehospital Post-resuscitation Care
Led by Siriraj Hospital · Updated on 2026-04-21
318
Participants Needed
1
Research Sites
48 weeks
Total Duration
On this page
AI-Summary
What this Trial Is About
Out-of-hospital cardiac arrest (OHCA) is a serious emergency condition with low survival rates despite improvements in resuscitation. Many patients experience rearrest after return of spontaneous circulation (ROSC), which greatly reduces chances of survival. This research evaluates a new evidence-based prehospital care protocol led by paramedics to reduce rearrest and improve outcomes in adult OHCA patients transported to Siriraj Hospital in Thailand. The study compares outcomes before and after implementing the new prehospital post-resuscitation care protocol. This protocol includes structured monitoring, specific oxygen and ventilation targets, use of vasopressors like norepinephrine, fluid management support, team communication, and training workshops with simulations. The intervention group receives this protocol, while the comparison group receives conventional post-cardiac arrest care by advanced life support units. Participants are monitored for rearrest occurrence within one hour after ROSC during prehospital and emergency department care. Researchers will also assess survival to hospital admission and discharge, as well as how well providers comply with the protocol. The study enrolls adults aged 18 and older with OHCA who achieved ROSC before hospital arrival. Total participation spans from pre-implementation data collection to two years of post-implementation follow-up. The goal is to inform scalable EMS guidelines that improve quality and survival in resource-limited settings.
CONDITIONS
Brief Title
Resuscitation Enhancement to Avoid Rearrest Through Evidence-based Strategies in Prehospital Post-resuscitation Care
Who Can Participate
Age: 18Years +
All Genders
Eligibility Criteria
You may qualify if you...
- Adults aged 18 years or older
- Patients with out-of-hospital cardiac arrest (OHCA) who received resuscitative care from the Siriraj Emergency Medical Services Center (SiEMS)
- Patients who achieved return of spontaneous circulation (ROSC) prior to hospital arrival
- Patients transported to the Emergency Department of Siriraj Hospital for further treatment
You will not qualify if you...
- Suspected traumatic cardiac arrest
- Patients whose legally authorized representative declined vasopressor administration despite clinical indication
- Patients who had not undergone endotracheal intubation and whose legally authorized representative declined it despite indication
- Patients without rearrest whose legally authorized representative declined further blood tests or procedures after arrival
- Patients whose legally authorized representative declined participation in the study
- Patients without an available legally authorized representative to provide consent for study participation
AI-Screening
AI-Powered Screening
Complete this quick 3-step screening to check your eligibility
1
2
3
Your Study Journey
Screening
Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Treatment
Duration - From return of spontaneous circulation until arrival at the emergency department
Participants receive prehospital post cardiac arrest care including fluid assessment and resuscitation, early vasopressor administration, and end-tidal CO2 monitoring in the prehospital phase.
1 prehospital treatment phase
Follow-up
Duration - Up to 30 days after hospital admission
Participants are monitored for rearrest and survival outcomes during hospitalization and up to 30 days after admission.
Visits during hospitalization and follow-up assessments up to 30 days
Trial Site Locations
Total: 1 location
1
Faculty of Medicine Siriraj Hospital, Mahidol University
Bangkok Noi, Bangkok, Thailand, 10700
Actively Recruiting
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Research Team
S
Sattha Riyapan, MD MPH
B
Bongkot Somboonkul, BS
How is the study designed?
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
NON_RANDOMIZED
Model
SEQUENTIAL
Primary Purpose
TREATMENT
Number of Arms
2
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Published Research Related To This Trial
Rationale and development of a prehospital goal-directed bundle of care to prevent rearrest after return of spontaneous circulation.
David G Dillon, Juan Carlos C Montoy, Nichole Bosson...
https://pubmed.ncbi.nlm.nih.gov/39503017Association between a Post-Resuscitation Care Bundle and the Odds of Field Rearrest after Successful Resuscitation from Out-of-Hospital Cardiac Arrest: A Pre/Post Study.
Jake Toy, Juliana Tolles, Nichole Bosson...
https://pubmed.ncbi.nlm.nih.gov/36692410Prehospital Post-Resuscitation Vital Sign Phenotypes are Associated with Outcomes Following Out-of-Hospital Cardiac Arrest.
Tanner Smida, Bradley S Price, Alan Mizener...
https://pubmed.ncbi.nlm.nih.gov/39088816Association of prehospital hypotension depth and dose with survival following out-of-hospital cardiac arrest.
Tanner Smida, James J Menegazzi, Remle P Crowe...
https://pubmed.ncbi.nlm.nih.gov/36191809Incidence and outcomes of rearrest following out-of-hospital cardiac arrest.
David D Salcido, Matthew L Sundermann, Allison C Koller...
https://pubmed.ncbi.nlm.nih.gov/25447433Incidence of rearrest after return of spontaneous circulation in out-of-hospital cardiac arrest.
David D Salcido, Amanda M Stephenson, Joseph P Condle...
https://pubmed.ncbi.nlm.nih.gov/20809686Rearrest after prehospital resuscitation.
E Brooke Lerner, Michael O'Connell, Ronald G Pirrallo
https://pubmed.ncbi.nlm.nih.gov/21054177Cardiovascular collapse after return of spontaneous circulation in human out-of-hospital cardiopulmonary arrest.
John Mark Chestnut, Andrew A Kuklinski, Shannon W Stephens...
https://pubmed.ncbi.nlm.nih.gov/21335581Survival and Rearrest in out-of-Hospital Cardiac Arrest Patients with Prehospital Return of Spontaneous Circulation: A Prospective Multi-Regional Observational Study.
Jae-Hyug Woo, Jin-Seong Cho, Choung Ah Lee...
https://pubmed.ncbi.nlm.nih.gov/32091295