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