Cardiac arrest treatment that uses resuscitator improves survival
Friday 13 November 2020
Using a life-saving device to mimic the functions of the heart and lungs has dramatically improved the survival of people who have suffered cardiac arrest out of hospital, according to a new study published today in The Lancet. The treatment program involving the life-support machine called extracorporeal membrane oxygenation (ECMO) was found to be so much more effective than standard treatment for this generally fatal disease that the trial was stopped early after recruiting only 30 of 165 expected patients.
The study, known as the Advanced Reperfusion Strategies for Refractory Cardiac Arrest (ARREST) trial, was funded by the National Heart, Lung, and Blood Institute (NHLBI), which is part of the National Institutes of Health. He found that using ECMO as part of a larger cardiac arrest program of care resulted in the survival of six of 14 patients compared to only one of 15 patients receiving standard therapy. Standard care for cardiac arrest typically includes cardiopulmonary resuscitation (CPR), defibrillation, intubation, and intravenous medication.
“This is the first trial to show a significant difference in outcomes after hospital admission in patients treated for out-of-hospital cardiac arrest with a team ECMO strategy,” said George Sopko, MD, MPH , program director in the NHLBI division. of Cardiovascular Sciences. “We can improve outcomes for this common health problem, and we believe this study is an important step in that direction. “
About 340,000 people die of cardiac arrest in the United States each year. The condition occurs when the heart suddenly stops beating. There is no blood flow to the body, including the heart and the brain. Immediate emergency treatment is essential to prevent death, but standard treatments are only marginally effective. Less than 10% of people with cardiac arrest survive. Some patients with cardiac arrest do not respond to any standard cardiac arrest therapy. ARREST investigators, led by Demetris Yannopoulos, MD, a cardiologist and professor of medicine at the Center for Resuscitation Medicine at the University of Minnesota Medical School in Minneapolis, speculated that this was because these patients had blockages. severe and extensive in the arteries of their hearts. To find out which approach might help patients with cardiac arrest, the ARREST trial compared standard treatment with ECMO treatment as soon as possible in 30 people with cardiac arrest. The average age was 61 years and 25 of the 30 patients were men.
The ECMO machine connects to a patient through tubes inserted into an artery and vein in the groin. The machine extracts blood from the patient’s body, pumps it through a part of the machine which acts as an artificial lung, and then sends it back to the body. This gives the doctors time to stabilize the patient and, if necessary, remove any blockages in the arteries of the heart.
Six of 14 people in ARREST who received ECMO (one of the ECMO patients refused to be included in the study) survived to discharge compared to only one of 15 who received standard treatment . Three and six months after discharge from hospital, all six people who received ECMO were alive and well compared to none of the patients who received standard treatment. The investigators noted that the substantial improvement in survival among those treated with ECMO was due to the comprehensive team-based care program implemented around it, and not to ECMO alone. This team program included protocols for emergency medical services to identify patients who could benefit the most, rapid transport to a hospital, rapid communication with an ECMO center to mobilize experienced operators who perform a high volume of ECMO procedures and care protocols after the patient is resuscitated. ECMO was only part of this treatment plan.
“The trial results make an important statement that early implementation of ECMO is the enabling and necessary condition that enables other advanced targeted therapies to be delivered to these critical patients. In his absence, the life-saving treatment that follows is simply not possible, ”said Yannopoulos.
“The favorable survival rate of this study is very encouraging and is helping to open new avenues in advanced cardiac care and transform outcomes for patients with cardiac arrest,” said Tom P. Aufderheide, MD, co- ARREST investigator, lead author of the study, and professor and director of the Resuscitation Research Center at the Medical College of Wisconsin, Milwaukee.
Due to this notable improvement in the survival of patients receiving this program of care, the ARREST Data and Safety Committee recommended in June that the study be discontinued. However, researchers continued to monitor survivors and found that the majority of patients treated under the ECMO program improved both functionally and neurologically for six months and then returned to near-normal life.
Investigators have continued to follow patients and plan to conduct a comprehensive analysis of the data, including looking at longer-term outcomes and costs of care. These results, they said, will be published in the subsequent publication of the study results. In a separate study, investigators report the results of the University of Minnesota’s ECMO-facilitated resuscitation program that serves Minneapolis-St. Paul metropolitan area.
About the National Heart, Lungs and Blood Institute (NHLBI): NHLBI is the world leader in conducting and supporting heart, lung and blood disease and sleep disorders research that advances scientific knowledge, improves public health and saves lives. For more information visit https://www.nhlbi.nih.gov.
About the National Institutes of Health (NIH):The NIH, the national agency for medical research, comprises 27 institutes and centers and is part of the US Department of Health and Human Services. The NIH is the principal federal agency that conducts and supports basic, clinical, and translational medical research, and studies the causes, treatments, and cures for common and rare diseases. For more information about the NIH and its programs, visit www.nih.gov.
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Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single-center, open-label randomized controlled trial. DOI: 10.1016 / S0140-6736 (20) 32338-2.