Resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiopulmonary resuscitation: A pilot study.

Levis, Anja; Greif, Robert; Hautz, Wolf E.; Lehmann, Lutz E.; Hunziker, Lukas; Fehr, Tobias; Haenggi, Matthias (2020). Resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiopulmonary resuscitation: A pilot study. Resuscitation, 156, pp. 27-34. Elsevier 10.1016/j.resuscitation.2020.08.118

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AIM

Resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiopulmonary resuscitation (CPR) increases coronary and cerebral perfusion pressure, which might improve neurologically intact survival after refractory cardiac arrest. We investigated the feasibility of REBOA during CPR in the emergency department.

METHODS

Patients in refractory cardiac arrest not qualifying for extracorporeal CPR were included in this pilot study. An introducer sheath was placed by ultrasound-guided puncture of the femoral artery, and a REBOA catheter was advanced to the thoracic aorta in 15 patients undergoing CPR. Primary outcome was correct placement within 10minutes of skin disinfection. Secondary outcomes included perfusion markers (mean central arterial blood pressure, end-tidal CO2, non-invasively measured cerebral oxygenation) and procedural information (number and duration of attempts, complications, verification of correct position and occlusion).

RESULTS

Successful catheter placement was achieved in 9 of the 15 patients (median 9min 30 s). Median interval from dispatch to start of the procedure was 59minutes. A small, albeit significant increase in non-invasively measured cerebral oxygenation was found, but none in blood pressure or end-tidal CO2. However, two patients with pulseless electrical activity of more than 20minutes achieved return of spontaneous circulation immediately after REBOA.

CONCLUSION

In this pilot trial, REBOA during CPR was successful in 60% of attempts. Long resuscitation times before start of the procedure might explain difficult insertion and missing effects. Nevertheless, insertion of REBOA in patients suffering from non-traumatic cardiac arrest is feasible and might increase coronary and cerebral perfusion pressures and perfusion.

FUNDING SOURCE

The study was supported the Bangerter-Rhyner Stiftung für medizinische Forschung, Switzerland, awarded to Anja Levis; the Stiftung zur Förderung der Forschung in Anästhesie und Intensivmedizin, Switzerland, awarded to Anja Levis; and departmental funds of the Departments of Anaesthesiology, Intensive Care Medicine, and Emergency Medicine of the Inselspital Bern, Switzerland.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Levis, Anja; Greif, Robert; Hautz, Wolf; Lehmann, Lutz Eric; Hunziker Munsch, Lukas Christoph and Hänggi, Matthias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1873-1570

Publisher:

Elsevier

Language:

English

Submitter:

Jsabelle Arni

Date Deposited:

11 Sep 2020 13:26

Last Modified:

23 Feb 2021 21:53

Publisher DOI:

10.1016/j.resuscitation.2020.08.118

PubMed ID:

32866549

Uncontrolled Keywords:

ALS Life Support Care CPR Cardiopulmonary Resuscitation Out-of-Hospital Cardiac Arrest Resuscitation

BORIS DOI:

10.7892/boris.146486

URI:

https://boris.unibe.ch/id/eprint/146486

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