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

Extracorporeal cardiopulmonary resuscitation for adults with shock‐refractory cardiac arrest

“…72 The ARREST trial (NCT3880565), a small phase 2 randomized trial was published showing significantly improved survival in the group that received early ECMO-facilitated resuscitation for refractory VF/VT out-of-hospital cardiac arrest. 73 This is the first RCT of ECMO-facilitated resuscitation versus standard ACLS treatment in patients with out-of-hospital cardiac arrest and refractory VF/VT and showed early initiation ECMO resulted in an impressive 43% survival to hospital discharge for refractory VF/VT out-of-hospital cardiac arrest. These either provide additional evidence of ECPR for refractory VF/VT cardiac arrest, or evidence supporting our conclusions that rigorous investigation in the form of RCTs is required to inform treatment guidelines and provide a bigger evidence base to inform practice, in order to optimize the entire chain of survival.…”

Evaluation of extracorporeal cardiopulmonary resuscitation eligibility criteria for out-of-hospital cardiac arrest patients

“…Yet, a systematic review by Holmberg et al found that the certainty of evidence still remains very low and there was critical risk of bias (20). A recent randomized trial has supported the use of ECPR-assisted resuscitation, but had an overall small sample size (4). Ongoing randomized clinical trials (NCT02832752, NCT03065647, and NCT03101787) may provide higher quality evidence to answer this question.…”

“…Observational studies have demonstrated improved outcomes for OHCA patients who receive ECPR versus traditional resuscitation, including increased survival to hospital discharge and improved neurological outcomes (1)(2)(3). Recently, a randomized trial of ECPR-facilitated resuscitation (ARREST trial) demonstrated improved survival to hospital discharge with ECPR compared to standard advanced cardiovascular life support (4).…”

Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: a scoping review

“…(ARREST) trial (ClinicalTrials.gov identifier: NCT03880565), funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health was recently published. 42 Patients with refractory ventricular fibrillation/ventricular tachycardia outof-hospital cardiac arrest were randomized to ECMO (n = 15) versus standard advanced cardiac life support (ACLS) (n = 15). This randomized trial showed early initiation ECMO-facilitated resuscitation resulted in an impressive 43% survival to hospital discharge.…”

“…Because of this notable improvement in survival of patients receiving this program of care, the trial was terminated early on June 2020 by NHLBI after recommendation from the Data and Safety Monitoring Board. 42 Given the patient population of interest is so small and rarely encountered and the health economics required to justify the large resource requirement surrounding ECPR, these trials will never randomized very large numbers of patients. Further randomized studies are being carried out and the results of these ongoing studies should provide a bigger evidence base to inform best practice.…”