• Katherine M Berg and Jasmeet Soar.
• Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
• Curr Opin Crit Care. 2021 Dec 1; 27 (6): 637-641.

Purpose Of ReviewThis review discusses potential reasons why many recent large trials in advanced cardiac life support have failed to demonstrate a difference in outcomes and suggests some points for consideration in planning future trials.Recent FindingsThe ARREST trial, a small controlled trial studying the effect of intra-arrest extracorporeal membrane oxygenation (ECMO, or E-CPR) on survival and functional outcome in patients with refractory ventricular fibrillation cardiac arrest, was stopped after 30 patients for benefit. This stands in contrast to several recent trials enrolling up to several thousand patients and finding no difference. Three ways in which the ARREST trial approach differed from that of other recent trials, and how those differences may contribute to the possibility of detecting the benefit of an intervention, are discussed.SummaryRefining our ability to select patients with potential to benefit from an intervention, providing those interventions earlier, and tailoring the specifics of an intervention to the individual patient all may be important in design of cardiac arrest trials, as illustrated by the large effect seen in the ARREST trial.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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