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Canadian Journal of Cardiology

A Second Chance for Survival: Clinical Trial Evidence, Eligibility, and Barriers to Implementation of ECPR for Out-of-Hospital Cardiac Arrest

Published:December 13, 2022DOI:https://doi.org/10.1016/j.cjca.2022.12.006
      The Advanced Reperfusion Strategies for Patients With OHCA and Refractory Ventribular Fibrillation (ARREST) trial enrolled 30 OHCAs (age 18 to 75) with initial shockable rhythms, randomized at hospital arrival (mean 911-to-randomization interval approximately 50 minutes) to continued conventional advanced life-support (ACLS) or ECPR (mean 911-to-ECPR interval 59 minutes; Supplemental Table S1).
      • Yannopoulos D.
      • Bartos J.
      • Raveendran G.
      • 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 controlled trial.
      The ECPR group demonstrated significant improvement in survival to hospital discharge (43% vs 6.7%) as well as 6-month favourable neurologic outcome (43% vs 0%; Supplemental Table S2). All ECPR-treated patients with poor hospital-discharge neurologic outcomes had favourable 6-month neurologic outcomes. The Data Safety Monitoring Board (DSMB) terminated the study early because of clear benefit.
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      References

        • Yannopoulos D.
        • Bartos J.
        • Raveendran G.
        • 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 controlled trial.
        Lancet. 2020; 396: 1807-1816
        • Belohlavek J.
        • Smalcova J.
        • Rob D.
        • et al.
        Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and immediate invasive assessment and treatment on functional neurologic outcome in refractory out-of-hospital cardiac arrest.
        JAMA. 2022; 327: 737
        • Bartos J.A.
        • Carlson K.
        • Carlson C.
        • et al.
        Surviving refractory out-of-hospital ventricular fibrillation cardiac arrest: critical care and extracorporeal membrane oxygenation management.
        Resuscitation. 2018; 132: 47-55
        • Grunau B.
        • Shemie S.D.
        • Wilson L.C.
        • et al.
        Current use, capacity, and perceived barriers to the use of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Canada.
        CJC Open. 2021; 3: 327-336
        • Matsuoka Y.
        • Goto R.
        • Atsumi T.
        • et al.
        Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a multi-centre prospective cohort study.
        Resuscitation. 2020; 157: 32-38