ARREST

Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial
D Yannopoulos et al. The Lancet 2020; https://doi.org/10.1016/S0140-6736(20)32338-2

Clinical Question
-  In adults suffering out of hospital cardiac arrest (OHCA) presenting with an initial rhythm of VF or pulseless VT, does the implementation of early ECMO facilitated resuscitation compared to standard ACLS resuscitation improve survival to hospital discharge?

N = 30, single centre in Minnesota USA

Authors’ Conclusions
-  Early ECMO-facilitated resuscitation for patients with OHCA and refractory VF significantly improved survival to hospital discharge when compared to standard ACLS treatment

The Bottom Line
-  This randomised trial showed early initiation ECMO resulted in an impressive 43% survival to hospital discharge for refractory shockable OHCA
-  The numbers involved were small, and this study was carried out in a centre that was experienced. It is therefore important for other centres to consider their expertise, local protocols and transport times
-  Further randomised work is being carried out (e.g. INCEPTION trial) and the results of these ongoing studies should provide a bigger evidence base to inform practice
-  I would advocate for the ongoing use of early ECMO in this patient cohort given the poor survival rates for standard ACLS