Cardiac Arrest Bundle of cARE Trial (CABARET): a feasibility randomised controlled study of a bundle of care intervention vs standard care.
Resuscitation plus · 2026-04-20 · Randomised trial
Abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) outcomes remain poor. Improving cerebral perfusion during cardiopulmonary resuscitation (CPR) to achieve better neurological outcomes is therefore a key priority. A bundled approach incorporating multiple CPR adjuncts has been proposed to enhance cerebral protection during OHCA. METHODS: CABARET was a multicentre randomised feasibility trial, designed to evaluate the deliverability of a novel resuscitation bundle during OHCA. Patients were randomised on scene in a 1:1 ratio to either usual care (advanced life support according to European Resuscitation Council 2021 guidelines) or a bundled intervention comprising: (1) head-up position CPR (HUP-CPR), (2) mechanical chest compressions using the LUCAS-3 device, and (3) an impedance threshold device (ITD). Primary feasibility outcomes included recruitment and randomisation rates, protocol adherence, training efficacy, and data collection completeness. RESULTS: All 32 of 32 planned patients were successfully recruited, representing 9.5% of potentially eligible OHCA cases. Three patients randomised to the intervention group did not receive the full bundle. Protocol adherence and training efficacy were high across participating sites. Data completeness was good overall, with the exception of peak end-tidal carbon dioxide measurements. CONCLUSIONS: The CABARET feasibility trial demonstrates that a head-up position and ITD CPR bundle can be delivered during OHCA with high fidelity and without impeding standard resuscitation care. Key insights regarding training, protocol compliance, and operational logistics provide a robust foundation for the design and conduct of a definitive randomised controlled trial.