# Advanced REperfusion STrategies- The ARREST Trial

> **NIH NIH R33** · UNIVERSITY OF MINNESOTA · 2020 · $553,986

## Abstract

Project Summary/Abstract
Background: Approximately 395,000 people suffer out-of-hospital cardiac arrest (OHCA) each year in the US.
The survival rate is <6%. Although ventricular tachycardia/fibrillation (VT/VF) constitutes only 30-35% of all
cardiac arrests, more than 80% of survivors present with VT/VF. These patients are also likely to have an
underlying reversible cause. Patients with refractory VT/VF, who have been emergently transported to the
cardiac catheterization laboratory (CCL) with CPR in progress, have been shown to have a >80% incidence of
clinically significant coronary stenosis. Thus, VT/VF is a strong predictor of acute coronary occlusion or stenosis,
potentially amenable to timely percutaneous coronary intervention (PCI). The refractory VT/VF population with
the worst prognosis (15% death rate) has the highest incidence of a treatable underlying cause. This subgroup
offers the greatest opportunity to impact OHCA survival and public health. Advanced perfusion/reperfusion
strategies now make it feasible to potentially reverse the underlying cause, including mechanical CPR, and
extracorporeal membrane oxygenation (ECMO) before and/or after PCI. Thus, investigators submitting this
application implemented a Refractory VT/VF Protocol as a standard of care in Minneapolis/St. Paul through the
comprehensively integrated, and collaborative Minnesota Resuscitation Consortium (MRC). During the first 12
months of protocol implementation, 62 sequential patients entered the CCL with CPR in progress. Overall,
survival to hospital discharge occurred in 28(45%) and functionally favorable survival (Cerebral Performance
Category 1 or 2) occurred in 26 (42%). Of the survivors, 26/28 (90%) had CPC 1 at one month. Historical and
concurrent data for the same population receiving standard resuscitation practice in MSP show survival of 15%
with CPC 1 OR 2. Proposed Clinical Trial We propose a single center, prospective feasibility/efficacy clinical
trial, to assess the role of early ECMO-facilitated CCL access compared to ED based resuscitation when ROSC
is required for CCL access. Both strategies represent current standards of care in our community. Two EMS
systems transport patients to the ED where resuscitation is continued until ROSC, followed by CCL access, or
death is declared. Three EMS systems transport patients to the University of MN for the ECMO-based early CCL
access protocol. Our 18-month preliminary experience shows that ECMO-based early CCL patients have higher
functionally favorable survival rates than conventional resuscitation practice. Specific Aim. Compare the rates
of survival to hospital discharge with Modified Rankin Scale Score (mRS) ≤3 in adult patients (18-75 years old)
with refractory VT/VF OHCA that are mobilized early to the U of MN and randomized to receive either: 1)
continued ED based resuscitation until achievement of ROSC followed by CCL access and PCI or determination
of death, or 2) early CCL access for ECMO support a...

## Key facts

- **NIH application ID:** 10022312
- **Project number:** 5R33HL142696-03
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** TOM Paul AUFDERHEIDE
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $553,986
- **Award type:** 5
- **Project period:** 2018-09-21 → 2021-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10022312

## Citation

> US National Institutes of Health, RePORTER application 10022312, Advanced REperfusion STrategies- The ARREST Trial (5R33HL142696-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10022312. Licensed CC0.

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