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

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