Resuscitation Enhancement to Avoid Rearrest Through Evidence-based Strategies in Prehospital Post-resuscitation Care
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Prehospital post cardiac arrest care protocol.
- Who it may be relevant to
- Registry conditions: Out-of-hospital Cardiac Arrest (OHCA). Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Thailand
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Overview
Out-of-hospital cardiac arrest (OHCA) remains a leading global emergency condition with low survival to hospital discharge despite advances in cardiopulmonary resuscitation. Return of spontaneous circulation (ROSC) rates have improved; however, 30-50% of patients experience rearrest after ROSC, which is associated with significantly reduced survival. Preventable physiologic factors related to prehospital care - including hypoxia, hypotension, and hyperventilation - are frequently identified prior to rearrest. Evidence-based post-ROSC clinical bundles exist mainly for in-hospital settings, while structured prehospital post-resuscitation care protocols are limited, particularly in resource-constrained environments. The RE-ARREST project aims to develop, implement, and evaluate an evidence-based prehospital post-resuscitation care protocol designed for paramedic-led Emergency Medical Services. The intervention includes structured monitoring, tailored oxygenation and ventilation targets, vasopressor use criteria (norepinephrine), fluid management decision support, teamwork communication, and operational training workshops using simulation. This is a quasi-experimental pre-post interventional study conducted at the Siriraj Emergency Medical Service (SiEMS), Thailand. The study compares outcomes from retrospective pre-implementation cases with prospective post-implementation cases, including both patient-centered outcomes and provider compliance. Adult OHCA patients with ROSC achieved prehospital and transported to Siriraj Hospital are eligible. The estimated sample size is 318 participants (pre-intervention 212; post-intervention 106) over two years. The primary outcome is the incidence of rearrest within 1 hour after ROSC during prehospital care and initial emergency department management. Secondary outcomes include protocol compliance, survival-to-admission, and survival-to-hospital-discharge. The protocol emphasizes feasibility, safety, and replicability to inform scalable EMS clinical practice guidelines. This research is expected to provide novel evidence on targeted prehospital post-ROSC care and has the potential to reduce rearrest, improve neurologically favorable survival, and strengthen EMS system quality improvement efforts in Thailand and other low-to-middle-resource settings.
Interventions
- Drug Prehospital post cardiac arrest care protocol
Prehospital post cardiac arrest care including: 1. Fluid assessment and resuscitation in prehospital phase 2. Early vasopressor in prehospital phase 3. Regular monitoriny end-tidal CO2 in prehospital phase
Primary outcome measures
- Rearrest rate [Time frame: From return of spontaneous circulation to first 1 hour in emergency room]
Secondary outcome measures (1)
- Survival to dischrage [Time frame: 30 days after admission]
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.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Non-randomized
- Model
- Sequential
- Masking
- Open label
- Primary purpose
- Treatment
Study locations
Thailand · 1 center
- Faculty of Medicine Siriraj Hospital, Mahidol University — Bangkok Noi
Publications
- Vos IA, Lucassen FG, Bens BWJ, Dercksen B, Postma R, Jorna EMF, Ter Maaten JC, Struys MMRF, Ter Avest E. Pre-hospital care after return of spontaneous circulation: Are we achieving our targets? Resusc Plus. 2024 Jun 21;19:100691. doi: 10.1016/j.resplu.2024.100691. eCollection 2024 Sep. PMID 39006133
- Dillon DG, Montoy JCC, Bosson N, Toy J, Kidane S, Ballard DW, Gausche-Hill M, Donofrio-Odmann J, Schlesinger SA, Staats K, Kazan C, Morr B, Thompson K, Mackey K, Brown J, Menegazzi JJ; California Resuscitation Outcomes Consortium. Rationale and development of a prehospital goal-directed bundle of care to prevent rearrest after return of spontaneous circulation. J Am Coll Emerg Physicians Open. 202 PMID 39503017
- Toy J, Tolles J, Bosson N, Hauck A, Abramson T, Sanko S, Kazan C, Eckstein M, Gausche-Hill M, Schlesinger SA. Association 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. Prehosp Emerg Care. 2024;28(1):98-106. doi: 10.1080/10903127.2023.2172633. Epub 2023 Feb 13. PMID 36692410
- Smida T, Price BS, Mizener A, Crowe RP, Bardes JM. Prehospital Post-Resuscitation Vital Sign Phenotypes are Associated with Outcomes Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2025;29(2):138-145. doi: 10.1080/10903127.2024.2386445. Epub 2024 Aug 15. PMID 39088816
- Smida T, Menegazzi JJ, Crowe RP, Weiss LS, Salcido DD. Association of prehospital hypotension depth and dose with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Nov;180:99-107. doi: 10.1016/j.resuscitation.2022.09.018. Epub 2022 Sep 30. PMID 36191809
- Salcido DD, Sundermann ML, Koller AC, Menegazzi JJ. Incidence and outcomes of rearrest following out-of-hospital cardiac arrest. Resuscitation. 2015 Jan;86:19-24. doi: 10.1016/j.resuscitation.2014.10.011. Epub 2014 Oct 23. PMID 25447433
- Salcido DD, Stephenson AM, Condle JP, Callaway CW, Menegazzi JJ. Incidence of rearrest after return of spontaneous circulation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 2010 Oct-Dec;14(4):413-8. doi: 10.3109/10903127.2010.497902. PMID 20809686
- Lerner EB, O'Connell M, Pirrallo RG. Rearrest after prehospital resuscitation. Prehosp Emerg Care. 2011 Jan-Mar;15(1):50-4. doi: 10.3109/10903127.2010.519820. Epub 2010 Nov 5. PMID 21054177
Identifiers
NCT: NCT07239908 · 801/2568(IRB4)