Preventing rearrest after out-of-hospital cardiac arrest with a paramedic post-ROSC care protocol

Resuscitation Enhancement to Avoid Rearrest Through Evidence-based Strategies in Prehospital Post-resuscitation Care

This project will test whether a structured prehospital post-resuscitation protocol delivered by paramedics can lower the chance of rearrest in adults who regain a pulse after out-of-hospital cardiac arrest.

Quick facts

• Phase: Phase2; Phase3
• Study type: Interventional
• Enrollment: 318 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Siriraj Hospital (Academic / other)
• Locations: 1 site (Bangkok Noi, Bangkok)
• Trial ID: NCT07239908 on ClinicalTrials.gov

What this trial studies

The RE-ARREST project develops and implements an evidence-based prehospital post-resuscitation care protocol tailored for paramedic-led Emergency Medical Services. The intervention emphasizes structured monitoring, tailored oxygenation and ventilation targets, vasopressor guidance, and clear procedures for transport and handoff to hospital teams. The protocol will be applied to adults with out-of-hospital cardiac arrest who achieve return of spontaneous circulation before hospital arrival and are transported by Siriraj EMS to Siriraj Hospital. Primary outcomes include rearrest rates prior to hospital arrival, survival to hospital discharge, and feasibility of protocol delivery in a resource-constrained prehospital setting.

Who should consider this trial

Good fit: Adults aged 18 years or older who experience out-of-hospital cardiac arrest, achieve ROSC before arrival, receive resuscitation from Siriraj EMS, and are transported to Siriraj Hospital are the intended participants.

Not a fit: Patients with suspected traumatic cardiac arrest, those whose legally authorized representative declines indicated interventions such as intubation or vasopressors, and people not treated or transported by Siriraj EMS are unlikely to be eligible or to benefit.

Why it matters

Potential benefit: If successful, the protocol could reduce rearrest after ROSC and improve survival to hospital discharge with better neurologic outcomes.

How similar studies have performed: In-hospital post-ROSC care bundles have shown benefit in prior work, but structured prehospital post-resuscitation protocols are relatively novel and have limited trial evidence, especially in resource-limited EMS systems.

Eligibility criteria

Inclusion Criteria:

* 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 subsequently transported to the Emergency Department of Siriraj Hospital for further treatment.

Exclusion Criteria:

* Suspected traumatic cardiac arrest.
* ROSC patients whose legally authorized representative declined vasopressor administration, despite clinical indication according to the prehospital post-resuscitation care protocol.
* ROSC patients who had not undergone endotracheal intubation, and whose legally authorized representative declined endotracheal intubation, despite protocol-based indication.
* ROSC patients without rearrest whose legally authorized representative declined further blood investigations or additional procedures after arrival at the Emergency Department.
* Patients whose legally authorized representative declined participation in the study.
* Patients without an available legally authorized representative to provide consent for study participation.

Where this trial is running

Bangkok Noi, Bangkok

• Faculty of Medicine Siriraj Hospital, Mahidol University — Bangkok Noi, Bangkok, Thailand (Recruiting)

Study contacts

• Principal investigator: Sattha Riyapan, MD MPH — Mahidol University
• Study coordinator: Sattha Riyapan, MD MPH

Conditions Out-of-hospital Cardiac Arrest; Post cardiac arrest care; Out-of-hospital cardiac arrest; Prehospital care