Methodology: 3.5/5
Usefulness: 3.5/5

Yannopoulos D, et al. Lancet. 2020 Dec 5;396(10265):1807-1816.

Question and Methods: The ARREST trial was a phase 2, single centre, open-label, RCT comparing early ECMO facilitated resuscitation to ED-based standard ACLS care for OHCA patients with refractory VF on survival to hospital discharge.
Findings: Survival to hospital discharge was observed in 1 of 15 patients in the standard ACLS treatment group (7%; 95% credible interval 1.6–30.2) versus 6 of 14 patient of 14 patients in the early ECMO-facilitated resuscitation group (43%; credible interval 21.3–67.7) (risk difference 36.2%, 3.7–59.2; posterior probability of ECMO superiority 0.9861).
Limitations: This was a small study of only 30 patients that was terminated early (due to benefit seen of treatment group – the treatment effect seen is likely over-exaggerated), conducted in a setting with a very well developed ECMO program, exceptional infrastructure/resources and trained staff to run the program that make generalizability of their results to other centres (including Ottawa) very challenging.

Interpretation: While this is a promising early RCT on the use of ECMO for the management of OHCA with refractory VF, larger multi-centre studies are required to confirm the benefits seen in this study before this resource intensive strategy is adopted on a larger scale.

By: Dr. Lindsay Cheskes

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.