ARREST (AmsteRdam REsuscitation STudies) studies out-of-hospital cardiac arrest in the province of North-Holland in the Netherlands.
In the Netherlands, 30.000 people have a sudden cardiac arrest each year, and approximately 8.000 out-of-hospital resuscitation attempts take place. Around 15 people die every day as a result of a cardiac arrest. Therefore, investigating which factors increase the risk of a cardiac arrest and studying how resuscitation attempts outside hospital are performed is very important.
The ARREST study is an ongoing prospective registry of all resuscitation attempts in the province of North Holland: an area of 2.9 million inhabitants. To this end ARREST cooperates with all ambulance services, dispatch centers and hospitals in the study regions, and collects data from police, fire fighters and lay persons to analyse the first response to a sudden cardiac arrest, including the effective use of automated external defibrillators (AEDs). ARREST records characteristics of out-of-hospital resuscitation attempts and studies risk factors of sudden cardiac arrest. The aim of the registry is to determine which factors matter most when it comes to patient survival, and to see where there are possibilities for improvement in the chain of survival.
Current research: Risk factors
Why does one person have a cardiac arrest whereas another person does not? ARREST studies which combination of risk factors can lead to the occurrence of a sudden cardiac arrest. We study the role of diseases and hereditary factors, but also the use of medication and environmental factors.
Genetic Factors Predisposing to Sudden Cardiac Arrest
Most deaths due to cardiac arrest are in older adults, particularly those with coronary artery disease. However, sudden cardiac arrest also affects the young. Understanding the genetic predisposition to sudden cardiac arrest is of utmost importance for its prevention in both the young and old. Identification of genetic factors that predispose an individual to sudden cardiac arrest is essential as it allows for specifically designed genetic testing that may contribute to faster and more efficient diagnosis and risk stratification in affected individuals.
Within the ARREST project we aim to discover which genetic factors predispose an individual to sudden cardiac arrest. To identify genetic factors that contribute to risk of sudden cardiac arrest we conduct genome wide association study (GWAS) that investigate the role of common genetic variants. Future work will also include other genetic analysis techniques such as WGS and WES (Whole Genome/Exome Sequencing). With these studies, we investigate the role of rare genetic variants. We especially hope to learn more about sudden cardiac arrest in younger individuals by doing this.
Metabolites as a New Predictor?
In addition to genetics, researchers are also looking at other factors in the blood. Currently, a study is (in collaboration with the LUMC) exploring the possibility of using certain substances in the blood - known as metabolites - as a new predictor (or biomarker) for the survival chances of patients after a sudden cardiac arrest. Metabolites are substances that are produced during and after metabolism. This study specifically focuses on people with diabetes, as their metabolism works differently.
Current research: Resuscitation characteristics
The role of citizen responders
In the event of an out-of-hospital cardiac arrest not only emergency medical services, but also the police, fire brigade and citizen responders are alerted. Since 2009 ARREST studies the effect of a citizen responder system. This research shows that alerting citizen responders increases the chance of survival by approximately 50%! Nowadays there is a nationwide citizen responder system in the Netherlands: HartslagNu. Together with HartslagNu, ARREST is investigating how this system can be designed even more effectively to further increase the chance of survival.
Airway Management and Ventilation
A crucial part of resuscitation is ventilation, as it ensures oxygen enters the blood. With the help of chest compressions, this oxygen-rich blood is then transported to vital organs, preventing ischemia (oxygen deprivation). There are different methods for ventilating a person. (Lay) rescuers often use mouth-to-mouth ventilation, while paramedics employ advanced techniques, known as airway management.
Currently, several projects within ARREST are focusing on airway management and ventilation by paramedics during resuscitation. These include exploratory studies mapping ventilation parameters (such as pressures, frequencies, and volumes) during out-of-hospital resuscitations, as well as studies comparing different methods. For example, studies are comparing extended ventilation pauses during mechanical chest compressions versus standard protocol (3 vs. 5 seconds), as well as comparing the 30:2 and 30:1 compression-ventilation ratios. Finally, research is being conducted to determine the optimal ventilation frequency for asynchronous (continuous) ventilation and the use of PEEP (Positive End-Expiratory Pressure).
Research with ECGs
After an out-of-hospital cardiac arrest, we receive the monitoring data from the ambulance services. This data includes the patient's electrocardiogram (ECG). Extensive research has been conducted with these recordings since the beginning of ARREST, and there are still many research questions that can be answered using this monitoring data.
Currently, one study is focused on mapping the incidence of refractory ventricular fibrillation and identifying factors that influence its incidence. Another study is working on creating an AI model that could predict the cause of cardiac arrest using the ECG.
Collaborations
ESCAPE-NET & PARQ COST Action
From January 2017 till January 2023 we officially worked together with other sudden cardiac arrest research groups in Europe, in the ESCAPE-NET project: European Sudden Cardiac Arrest Network - Towards Prevention, Education and New Effective Treatment, supported by the EU. In this project, international experts with different backgrounds worked together sharing their data, knowledge and expertise.
The PARQ project (from October 2020 till October 2024) is another international project in which we also, supported by the EU, worked together with other European research groups. The project stands for: 'Sudden cardiac arrest prediction and resuscitation network: Improving the quality of care". With PARQ we aimed to expand the network of international sudden cardiac arrest researchers further.
PREMEDICARE COST Action
Since October 2025, ARREST has been involved in a new four-year COST Action project: the PREMEDICARE project (‘Precision Medicine for Cardiac Arrest’). In this project, we are collaborating with an international and multidisciplinary team of experts to better understand the causes and long-term effects of Out-of-Hospital Cardiac Arrest (OHCA) in individuals under the age of 50 in Europe. The aim is to promote and support the development and application of personalized medicine for this patient group.
Team
| J.L. van Schuppen, MD, PhD | Anaesthesiologist, Project leader Resuscitation Research |
| H.L. Tan, MD, PhD | Cardiologist, Project leader Risk at Sudden Cardiac Arrest |
| R.W. Koster, MD, PhD | Cardiologist, founder, advisor |
| C. van der Werf, MD, PhD | Cardiologist, post-doc |
| Prof. P.R. Schober, MD, PhD | Professor of anesthesiology, anaesthesiologist, statistician |
| M.M. Schwarte-Ekkel, MSc | Research coördinator |
| R. Stieglis, MSc | Datacoördinator, PhD Student |
| V.G.M. van Eeden, MSc | Datamanager |
| R. Kalk, MSc | Datamanager |
| E.C. Linssen, MSc. | Datamanager |
| B.J. Verkaik, MD | PhD Student, physician |
| J. van der Laan, MSc | Researcher |
| J.A. van Eijk, MD | PhD Student, physician |
| M. Bak, MSc, PhD | Post-doc |
| L.C. Doeleman, MD | PhD Student, physician |
| D.S. Zimmerman, MSc | PhD Student |
| S. Keshtkar, MD | Researcher, physician |
| D.T. Weigel, MD | Researcher, physician |
| W.A.J.J. Willems, MD | Research assistent, physician |
| N.F. Alibux | Research assistent |
Partners
ARREST collaborates with:
- Ambulance services and emergency dispatch centers
- Fire Department
- Police Department
- Hospitals
- General practitioners
- Pharmacies
- Dutch Heart Foundation
- HartslagNu
- AED owners, operators, and suppliers
- Dutch Resuscitation Council (NRR)
- European Resuscitation Council (ERC)
- European Heart Rhythm Association, European Society of Cardiology
Data from ARREST is also part of four European collaborations:
- ESCAPE-NET
- EuReCa
- COSTA
- PARQ COST Action
ARREST is financed by several organisations:
- EU H2020 grant agreement nr 733381
- DCVA 'Dutch CardioVascular Alliance’/CVON ‘CardioVasculair Onderzoek Nederland’: Dutch Heart Foundation, NFU, NWO, and KNAW (no. 2012-10 PREDICT project)
- Dutch Heart Foundation
- NWO, grant ZonMW Vici 918.86.616
- Medicines Evaluation Board (MEB/CBG)
- Laerdal Foundation
- Industry: Stryker, Zoll medical services, Cardiac Science, Defibtech, Philips (none of these companies has any influence on research questions, methods and results of ARREST).
Publications
Visit our PubMed Collection to view all our publications.
