Clinical trial led by U of M Medical School improves care for cardiac arrest patients

Callan Gray

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Cardiac arrest patients are more likely to survive under a new standard of care in the Twin Cities. The advancement follows a clinical trial led by the University of Minnesota Medical School.

During cardiac arrest, a patient’s heart stops beating and their blood stops flowing. Fewer than 10% of people survive a cardiac arrest, according to the National Institutes of Health.

“It takes a toll on the whole body,” said Dr. Demetris Yannopoulos, a cardiologist and a professor of Medicine and Emergency Medicine at the University of Minnesota Medical School, plus director of the Center for Resuscitation Medicine.

Yannopolous and a team of researchers studied whether using an extracorporeal membrane oxygenation (ECMO) machine could help improve outcomes.

It’s a set of tubes that takes blood from the heart, out of the body, into a machine that oxygenates it and then sends it back into the body through another set of tubes.

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“All of the organs get normal blood pressure and oxygen to go about doing their job,” Yannopolous said.

ECMO has been used for years to treat other heart conditions.

“A lot of patients that suffer cardiac arrest in and out of the hospital setting, they have severe blockages in their arteries that are the cause of that heart to stop,” Yannopolous said. “We said, ‘Well, we have this machine, why don’t we start putting this machine to stabilize the patient?’ And we can work to find — and reverse — the cause of the arrest.”

He told 5 EYEWITNESS NEWS they started trying it about five years ago and saw early success. They needed to do a clinical trial, however, to know for sure that this machine is what made the difference in saving lives.

“Unless we do that, we cannot provide the best care for our patients and our citizens,” he said.

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The ARREST trial was funded by the National Heart, Lung and Blood Institute under the National Institutes of Health.

From Aug. 8, 2019 to June 14, about 30 patients participated. When they arrived at the hospital, they were randomly selected to either get the standard of care or the new treatment, Yannopolous said.

The standard of care has been CPR, defibrillation, intubation and intravenous medications.

Only one of 15 people who received the standard of care survived compared to six of the 14 who received ECMO-facilitated resuscitation as part of the system of care.

“We were following patients up to six months and we have had all six survivors survive after six months and none of the standard group survived,” Yannopolous said. “As a magnitude of intervention is one of the largest positive trials that have ever been recorded in cardiology in resuscitation science.”

The team of researchers had planned to enroll more than 75 patients but it was ended early.

The Data Safety Monitoring Board, which operates under the NIH and is the oversight committee that ensures the safety of patients in clinical trials, decided it was unethical to continue denying some patients the care.

“When they looked at the outcomes, they unanimously recommended to stop the trial early because the early ECMO resuscitation strategy led to almost seven times higher survival rate compared to the prior standard of care,” Yannopolous said.

The results were published in the medical journal The Lancet last month.

“This is currently the standard of care in Twin Cities, Minneapolis-St. Paul area because we do have the capabilities,” Yannopolous said. “We are experimenting with processes for how to do it better so we can provide the blueprint to other communities in the United States willing to do this.”

He also hopes it will give the NIH the framework to provide funding to figure out how to do training and implementation of the early ECMO-facilitated resuscitation.