Open AccessEmergency department initiated resuscitative endovascular balloon occlusion of the aorta (REBOA) for out‐of‐hospital cardiac arrest is feasible and associated with improvements in end‐tidal carbon dioxide
Author(s) -
Daley James,
Buckley Ryan,
Kisken Kathryn Can,
Barber Douglas,
Ayyagari Raj,
Wira Charles,
Aydin Ani,
Latich Igor,
Lozada Juan Carlos Perez,
Joseph Daniel,
Marino Angelo,
Mojibian Hamid,
Pollak Jeffrey,
Chaar Cassius Ochoa,
Bonz James,
Belsky Justin,
Coughlin Ryan,
Liu Rachel,
Sather John,
Van Tonder Reinier,
Beekman Rachel,
Fults Elyse,
Johnson Austin,
Moore Christopher
Publication year - 2022
Publication title -
journal of the american college of emergency physicians open
Language(s) - English
Resource type - Journals
ISSN - 2688-1152
DOI - 10.1002/emp2.12791
Subject(s) - medicine , return of spontaneous circulation , pulseless electrical activity , emergency department , cardiopulmonary resuscitation , aorta , anesthesia , advanced cardiac life support , cardiology , resuscitation , emergency medicine , psychiatry
Objectives Out‐of‐hospital cardiac arrest (OHCA) claims the lives of approximately 350,000 people in the United States each year. Resuscitative endovascular balloon occlusion of the aorta (REBOA) when used as an adjunct to advanced cardiac life support may improve cardio‐cerebral perfusion. Our primary research objective was to determine the feasibility of emergency department (ED)‐initiated REBOA for OHCA patients in an academic urban ED. Methods This was a single‐center, single‐arm, early feasibility trial that used REBOA as an adjunct to advanced cardiac life support (ACLS) in OHCA. Subjects under 80 years with witnessed OHCA and who received cardiopulmonary rescuitation (CPR) within 6 minutes were eligible. Results Five patients were enrolled between February 2020 and April 2021. The procedure was successful in all patients and 4 of 5 (80%) patients had transient return of spontaneous circulation (ROSC) after aortic occlusion. Unfortunately, all patients re‐arrested soon after intra‐aortic balloon deflation and none survived to hospital admission. At 30 seconds post‐aortic occlusion, investigators noted a statistically significant increase in end tidal carbon dioxide of 26% (95% confidence interval, 10%, 44%). Conclusion Initiating REBOA for OHCA patients in an academic urban ED setting is feasible. Aortic occlusion during chest compressions is temporally associated with improvements in end tidal carbon dioxide 30 seconds after aortic occlusion. Four of 5 patients achieved ROSC after aortic occlusion; however, deflation of the intra‐aortic balloon quickly led to re‐arrest and death in all patients. Future research should focus on the utilization of partial‐REBOA to prevent re‐arrest after ROSC, as well as the optimal way to incorporate this technique with other endovascular reperfusion strategies.