EVIDENCE trial

Sutherland ED & the Cardiology department are excited to be participating in EVIDENCE, a large multi-centre trial.

Call 2222 “Evidence” for enrolled patients in hours. Aiming for cath lab < 1 hour from arrest.

Collect data on all cardiac arrest patients, regardless of enrolment.

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Hypothesis: In patients with out of hospital cardiac arrest, a bundle of care which includes

1. expedited transfer to hospital after 15 minutes resuscitation,
2. mechanical CPR on route, and
3. urgent coronary angiography on arrival to hospital,

will improve neurologically favourable survival.

A brief summary of the trial is below, the attached power point presentation provides more detail.

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Ambulance will:

•  enrol patients with VT/VF or PEA arrest
  • randomised to “expedited care” or “usual care”
• notify ED via BAT phone of incoming EVIDENCE patient receiving mechanical CPR
• transfer “expedited” care patients to hospital after 15 minutes resuscitation
• give a 60 second handover in resus before transfer to ED LUCAS +/- ED trolley

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If patient is enrolled Monday – Friday 0800 -1700 Emergency Department team will:

• notify cardiology pre-hospital  –  dial 2222 “EVIDENCE”
• assemble resus team (see below resus schema) and prepare to follow usual ALS protocols
• transfer patient to  ED LUCAS during ambulance handover
• transfer “expedited care” patients to cath lab urgently – IN HOURS*
  • immediately if VT/VF arrest (even if no ROSC)
  • ED SMO to establish that team can achieve  “needle to skin” within 1 hour of arrest time
    • generally <50 min since arrest on arrival to ED
    • check functioning ETT
  •  if PEA arrest
    • urgent cath lab if clinically indicated
• ED will handover to cath lab anaesthetist in lab​

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Data will be collected on all ED OOHCA patients (regardless of enrolment in the trial or time of day)

• please use the template below for documenting cardiac arrest
  • save the attached  doc as a pre-completed note in EMR, and use this for all OOHCA to assist with data collection
• it can also serve as an aide memoire for the processes required during any ALS , as well as for the EVIDENCE trial​
• instructions to create a pre-completed note are in the above powerpoint

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Questions or concerns?

–          Kelly Wright CNC will be the main ED investigator for this trial – she will attend all arrests in hours to assist with data collection and patient flow.

–          Dr Allison Moore and Dr Matthew Allan are the medical leads for ED and cardiology, respectively – please contact us if you have concerns.

–          There will be sim sessions in the near future to practice “expedited care” for OOHCA.

–          Patients are only eligible for “expedited care” In Hours – usual care should be continued for all other OOHCA patients.

–          Please take this opportunity to review your knowledge of ALS protocols, and modifications for use with all potential COVID patients.