ACLS vs. eCPR for refractory VF

What we learned from the ARREST Trial about ECMO-facilitated resuscitation in OHCA refractory ventricular fibrillation


Electrical storm has dismal outcomes. It is most frustrating because we know the cause is very likely coronary occlusion (at about 75%). While some are implementing early ECMO, the Montgomery County Hospital District EMS has added esmolol to its toolbelt to try and improve refractory VF outcomes.

In this episode of the MCHD Paramedic Podcast, our host, Casey Patrick, MD, FAEMS, MCHD’s assistant medical director, is joined by MCHD Cardiac Coordinator, Brad Ward, to discuss the ARREST Trial, recently released in The Lancet.

The ARREST Trial is the first randomized trial comparing standard advanced cardiac life support (ACLS) treatment to extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation in patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation. The researchers examined data from three EMS transporting systems over the course of about a year (August 2019-June 2020).

Join our hosts to learn more about ECMO, why the ARREST Trial was halted, and whether the results are applicable to your agency.

Read more: Is eCPR the future of refractory vfib management?

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