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.

Abstract

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. METHOD(S): 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). RESULT(S): 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<0.001) and increased survival with favourable neurological outcome (16% vs 30%; p<0.001). Improvements were most evident in patients with shockable rhythms (62% vs 42%; p=0.001). No difference was observed for non-shockable rhythms (94% vs 93%; p=0.81). CONCLUSION(S): Implementation of the BCIS conveyance algorithm improves 30-day survival and neurological outcomes in OHCA patients with shockable rhythms when transported directly to a CAC. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact