The effect of SPecialty cAre on Recovery from Cardiac arrest (the SPARC trial)

Abstract Cardiac arrest is common and deadly. Over 150,000 Americans are admitted to the hospital after resuscitation from cardiac arrest each year. These vulnerable patients require complex and time sensitive care to treat the causes and consequences of cardiac arrest. Delivery of excellent post-arrest care improves survival and quality of recovery. Unfortunately, hospital-level variability in case volume, resources, and provision of recommended treatments results in tens of thousands of avoidable deaths annually. For these reasons, the American Heart Association and National Academies of Medicine recommend comprehensive systems of post- arrest care be created, which may include specialized centers. What comprises these systems and specialty centers remains a key knowledge gap. This randomized controlled trial will test the effect of transfer to an existing specialty center compared to usual care for patients resuscitated from out-of-hospital cardiac arrest. Our results will define the value of a specialized system of care and identify the necessary minimum components needed to confer benefit from specialty care. This single system, regional Phase II trial will allow future multicenter implementation and testing of specialty care by: 1) estimating the effect of transfer to specialty care on functional recovery after cardiac arrest in an optimal environment; 2) leveraging variability in participating usual care centers to elucidate the minimal clinical and operational standards for specialty cardiac arrest centers; and, 3) rigorously characterizing ancillary costs and benefits of transfer to specialty care. This trial will inform public policy and the clinical approach to one of the most lethal syndromes in medicine.