Thursday, March 4, 2021

ECMO + Angio/Cath for RVF

REBEL EM - March 04, 2021 - By Matt Astin
Paper: Yannopoulos 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 Control Trial. Lancet. PMID: 33197396
“Clinical question: Does extracorporeal membrane oxygenation (ECMO) resuscitation coupled with immediate coronary angiography/catheterization improve survival compared to standard ACLS in the emergency department?
Author Conclusión: “Early ECMO-facilitated resuscitation for patients with OHCA and refractory ventricular fibrillation significantly improved survival to hospital discharge and functional status compared with patients receiving standard ACLS resuscitation.”
Clinical Take Home Point: ECMO provides a promising opportunity to increase meaningful survival for OHCA patients with refractory VF or VT. However, this is a time- and resource-intensive modality that is not available in all settings. Continue to provide high-quality CPR, defibrillate early, and search for reversible causes. If ROSC is achieved, evaluate for evidence of acute coronary occlusion and the need for emergent coronary revascularization.”