Monday, December 14, 2020


First 10EM - December 14, 2020 - By Justin Morgenstern
The paper
The ARREST trial Yannopoulos D, Bartos J, Raveendran G, Walser E, et al. 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. 
Lancet. 2020 Nov 12:S0140-6736(20)32338-2. doi: 10.1016/S0140-6736(20)32338-2. 
Epub ahead of print. PMID: 33197396 NCT03880565
"The Results
They included 30 patients, with a mean age of 59 years, 83% of whom were men.
The results were pretty dramatic. There was a large improvement in the primary outcome of survival to hospital discharge (43% versus 7%, ARR 36%, 95% CI 3.7-59.2%). Survival to 3 and 6 months was also better in the ECMO CPR group (43% vs 0%, p=0.006). 
Bottom line
This is a promising early study of ECMO in the management of out of hospital cardiac arrest with a shockable rhythm. That being said, this is a small study with many potential sources of bias. Larger studies will be needed to confirm the dramatic benefits seen here."