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27 de ago. de 2023 · The ARREST trial is an investigator-led, prospective, parallel, multicentre, open-label, randomised superiority trial in which expedited transfer to a cardiac arrest centre was compared with current standard of care, comprising patient transfer to the geographically closest emergency department following resuscitated OHCA.
13 de nov. de 2020 · To our knowledge, the ARREST trial is the first randomised interventional trial to assess the effect of early ECMO-facilitated resuscitation compared with standard ACLS treatment for survival of patients with out-of-hospital refractory cardiac arrest.
- Demetris Yannopoulos, Jason Bartos, Ganesh Raveendran, Emily Walser, John Connett, Thomas A Murray, ...
- 2020
5 de dic. de 2020 · 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 Dec 5;396 (10265):1807-1816. doi: 10.1016/S0140-6736 (20)32338-2. Epub 2020 Nov 13. Authors.
- Demetris Yannopoulos, Jason Bartos, Ganesh Raveendran, Emily Walser, John Connett, Thomas A Murray, ...
- 2020
3 de jul. de 2021 · The ARREST trial was a phase 2, single-centre, open-label, adaptive, safety and efficacy randomised clinical trial comparing early extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to standard advanced cardiac life support (ACLS) in adults with out-of-hospital refractory ventricular fibrillation cardiac arrest.
- Jason A Bartos, Demetris Yannopoulos
- 2021
- Clinical Question
- Background
- Design
- Setting
- Population
- Outcome
- Authors’ Conclusions
- Strengths
- Weaknesses
- The Bottom Line
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 standa...
OHCA has a well documented poor survival rateHalf of all patients with VF and OHCA have refractory VF which has a much worse prognosisThe evidence for the use of ECMO in OHCA is from observational cohort studies with no randomised trials to dateThe 2CHEERtrial published this year (both OHCA and IHCA with presumed cardio-respiratory origin), showed 44% of patients had survival to hospital discharge with a favourable neurological outcomePhase 2, single centre, open-label RCTOn hospital arrival, member of study team would verify eligibility and randomisation would occurFunctional assessment at 3 and 6 months done by qualified assessors blinded to group allocationPre-specified secondary outcomes included:University of Minnesota Medical Center, USAAugust 2019 – June 2020Inclusion:Exclusion:36 patients assessed > 30 patients enrolled and randomly assigned (15 in each arm)Baseline Demographics similar (ECMO v ACLS)Primary outcome:Secondary outcomes:Adverse Events:Early ECMO-facilitated resuscitation for patients with OHCA and refractory VF significantly improved survival to hospital discharge when compared to standard ACLS treatment
Well done randomised trial in a logistically complex cohort of patientsAnalysed on ITT basisExcellent safety reporting measuresThe statistical plan for randomisation ratios seems complex but given the evidence base prior surrounding ECMO and its improved survival rates then the protocol to continually adapt the numbers of...Single center study reduces external validitySmall numbers of patientsIt would be interesting to see the breakdown of CPC scoresNo cost analysis done despite being one of the listed secondary outcomes on the trial protocolThis randomised trial showed early initiation ECMO resulted in an impressive 43% survival to hospital discharge for refractory shockable OHCAThe 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 transp...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 practiceI would advocate for the ongoing use of early ECMO in this patient cohort given the poor survival rates for standard ACLS25 de ene. de 2023 · The ARREST trial was terminated early because of superiority of the intervention: survival to discharge occurred in 6 of 14 patients (43%) in the group that received extracorporeal CPR as...
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