Out-of-hospital Cardiac Arrest (OHCA)Phase 2/3RE-ARRESTNCT07239908
Resuscitation Enhancement to Avoid Rearrest Through Evidence-based Strategies in Prehospital Post-resuscitation Care
A Phase 2/3 study testing Prehospital post cardiac arrest care protocol in people with Out-of-hospital Cardiac Arrest (OHCA), run by Siriraj Hospital at 1 site in Thailand.
Trial summary
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… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Out-of-hospital Cardiac Arrest (OHCA)
- What is being tested?
- Prehospital post cardiac arrest care protocol
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 318 participants
- Where
- 1 siteThailand
- Study dates
- 1 Dec 2025to 1 Dec 2028
- Phase
- Phase 2/3
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Thailand1 site, 1 recruiting
- Recruiting
Faculty of Medicine Siriraj Hospital, Mahidol University
Bangkok Noi, Bangkok, 10700
Sattha Riyapan, MD, MPH, +66-2-419-9216, sattha.riy@mahidol.ac.th
About this study
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.
Read more
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.
- Conditions
- Out-of-hospital Cardiac Arrest (OHCA)
- Being tested
- Prehospital post cardiac arrest care protocol
- Keywords
- Post cardiac arrest care, Out-of-hospital cardiac arrest, Prehospital care
- Medical subject headings
- Out-of-Hospital Cardiac Arrest
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Prehospital post cardiac arrest care protocolDrug
Prehospital post cardiac arrest care including:
- Fluid assessment and resuscitation in prehospital phase
- Early vasopressor in prehospital phase
- Regular monitoriny end-tidal CO2 in prehospital phase
| Study group | Role | What they receive |
|---|---|---|
| No intervention | No intervention | Conventional post cardiac arrest care by ALS unit in Bangkok Thailand |
| Prehospital post cardiac arrest care protocol | Experimental | Prehospital post cardiac arrest care protocol Receives: Drug: Prehospital post cardiac arrest care protocol |
What is being measured
The primary outcome is the main question the study is designed to answer.
Rearrest rate
patient who has return of spontaneous circulation and then has no pulse again
Measured: From return of spontaneous circulation to first 1 hour in emergency room
Secondary outcomes (1)
Survival to dischrage
patient who survival after admit to hospital
Measured: 30 days after admission
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Nov 2025
- Study start1 Dec 2025
- Primary completion31 Dec 2027 (estimated)
- Study completion1 Dec 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (11)Papers the sponsor has linked to this study.
- Other trials for Out-of-hospital Cardiac Arrest (OHCA)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2/3
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Model description
- Prehospital post cardiac arrest care protocol for advanced life support ambulance
- Masking
- None (open label)
- Enrolment
- 318 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Siriraj Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Sattha Riyapan, Siriraj Hospital
- Investigators
- Sattha Riyapan, MD MPH, Principal investigator, Mahidol University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07239908
- Sponsor's protocol ID
- 801/2568(IRB4)
- Acronym
- RE-ARREST
- Status last verified
- Apr 2026
- First submitted
- 16 Nov 2025
- Last updated
- 21 Apr 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: only IPD used in the results publication.
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.
PubMed 39006133Dillon 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. 2024 Nov 5;5(6):e13321. doi: 10.1002/emp2.13321. eCollection 2024 Dec.
PubMed 39503017Toy 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.
PubMed 36692410Smida 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.
PubMed 39088816Smida 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.
PubMed 36191809Salcido 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.
PubMed 25447433Salcido 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.
PubMed 20809686Lerner 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.
PubMed 21054177Chestnut JM, Kuklinski AA, Stephens SW, Wang HE. Cardiovascular collapse after return of spontaneous circulation in human out-of-hospital cardiopulmonary arrest. Emerg Med J. 2012 Feb;29(2):129-32. doi: 10.1136/emj.2010.108340. Epub 2011 Feb 18.
PubMed 21335581Woo JH, Cho JS, Lee CA, Kim GW, Kim YJ, Moon HJ, Park YJ, Lee KM, Jeong WJ, Choi IK, Choi HJ, Choi HJ. Survival and Rearrest in out-of-Hospital Cardiac Arrest Patients with Prehospital Return of Spontaneous Circulation: A Prospective Multi-Regional Observational Study. Prehosp Emerg Care. 2021 Jan-Feb;25(1):59-66. doi: 10.1080/10903127.2020.1733716. Epub 2020 Mar 20.
PubMed 32091295Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010 Nov;81(11):1479-87. doi: 10.1016/j.resuscitation.2010.08.006. Epub 2010 Sep 9.
PubMed 20828914
Study at a glance
From the registry record, last updated by the sponsor on 21 Apr 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Resuscitation Enhancement to Avoid Rearrest Through Evidence-based Strategies in Prehospital Post-resuscitation Care
- ClinicalTrials.gov ID
- NCT07239908
- Acronym / sponsor ID
- RE-ARREST / 801/2568(IRB4)
- Conditions
- Out-of-hospital Cardiac Arrest (OHCA)
- Keywords
- Post cardiac arrest care, Out-of-hospital cardiac arrest, Prehospital care
- Phase
- Phase 2/3
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 318 participants (estimated)
- Lead sponsor
- Siriraj HospitalUniversity, hospital or other
- Study start
- 1 Dec 2025 (actual)
- Primary completion
- 31 Dec 2027 (estimated)
- Study completion
- 1 Dec 2028 (estimated)
- First posted
- 20 Nov 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Prehospital post cardiac arrest care protocol for advanced life support ambulance
| Arm | Type | Receives |
|---|---|---|
| No intervention | No intervention | –Conventional post cardiac arrest care by ALS unit in Bangkok Thailand |
| Prehospital post cardiac arrest care protocol | Experimental | Drug: Prehospital post cardiac arrest care protocolPrehospital post cardiac arrest care protocol |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- 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.
Key exclusion criteria (6 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Prehospital post cardiac arrest care protocolPrehospital 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 | Drug | Prehospital post cardiac arrest care protocol |
Primary outcome
Rearrest rate
Time frame: From return of spontaneous circulation to first 1 hour in emergency room
patient who has return of spontaneous circulation and then has no pulse again
1 secondary outcome
Survival to dischrage
Time frame: 30 days after admission
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 21 Apr 2026.
- Background: PubMed 39006133Vos 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.
- Background: PubMed 39503017Dillon 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. 2024 Nov 5;5(6):e13321. doi: 10.1002/emp2.13321. eCollection 2024 Dec.
- Background: PubMed 36692410Toy 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.
- Background: PubMed 39088816Smida 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.
- Background: PubMed 36191809Smida 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.
- Background: PubMed 25447433Salcido 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.
- Background: PubMed 20809686Salcido 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.
- Background: PubMed 21054177Lerner 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.
- Background: PubMed 21335581Chestnut JM, Kuklinski AA, Stephens SW, Wang HE. Cardiovascular collapse after return of spontaneous circulation in human out-of-hospital cardiopulmonary arrest. Emerg Med J. 2012 Feb;29(2):129-32. doi: 10.1136/emj.2010.108340. Epub 2011 Feb 18.
- Background: PubMed 32091295Woo JH, Cho JS, Lee CA, Kim GW, Kim YJ, Moon HJ, Park YJ, Lee KM, Jeong WJ, Choi IK, Choi HJ, Choi HJ. Survival and Rearrest in out-of-Hospital Cardiac Arrest Patients with Prehospital Return of Spontaneous Circulation: A Prospective Multi-Regional Observational Study. Prehosp Emerg Care. 2021 Jan-Feb;25(1):59-66. doi: 10.1080/10903127.2020.1733716. Epub 2020 Mar 20.
- Background: PubMed 20828914Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010 Nov;81(11):1479-87. doi: 10.1016/j.resuscitation.2010.08.006. Epub 2010 Sep 9.
- Individual participant dataSharing planned: Yes. only IPD used in the results publication.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Sattha Riyapan, MD MPH principal investigator
Mahidol University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2/3 study testing Prehospital post cardiac arrest care protocol in people with Out-of-hospital Cardiac Arrest (OHCA), run by Siriraj Hospital at 1 site in Thailand.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 21 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Thailand. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Sattha Riyapan, MD MPH (+66994489090, sattha.riy@mahidol.ac.th), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Rearrest rate (time frame: From return of spontaneous circulation to first 1 hour in emergency room). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07239908, which also lists 11 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Apr 2026.