Abstract
Background
Resuscitative endovascular balloon occlusion of the aorta (REBOA) reportedly elevates
arterial blood pressure (ABP) during non-traumatic cardiac arrest.
Objectives
This randomized, blinded trial of cardiac arrest in pigs evaluated the effect of automated
REBOA two minutes after balloon inflation on ABP (primary endpoint) as well as arterial
blood gas values and markers of cerebral haemodynamics and metabolism.
Methods
Twenty anesthetized pigs were randomized to REBOA inflation or sham-inflation (n = 10
in each group) followed by insertion of invasive monitoring and a novel, automated
REBOA catheter (NEURESCUE® Catheter & NEURESCUE® Assistant). Cardiac arrest was induced
by ventricular pacing. Cardiopulmonary resuscitation was initiated three min after
cardiac arrest, and the automated REBOA was inflated or sham-inflated (blinded to
the investigators) five min after cardiac arrest.
Results
In the inflation compared to the sham group, mean ABP above the REBOA balloon after
inflation was higher (inflation: 54 (95%CI: 43–65) mmHg; sham: 44 (33–55) mmHg; P = 0.06), and diastolic ABP was higher (inflation: 38 (29–47) mmHg; sham: 26 (20–33) mmHg;
P = 0.02), and the arterial to jugular oxygen content difference was lower (P = 0.04). After return of spontaneous circulation, mean ABP (inflation: 111 (95%CI:
94–128) mmHg; sham: 94 (95%CI: 65–123) mmHg; P = 0.04), diastolic ABP (inflation: 95 (95%CI: 78−113) mmHg; sham: 78 (95%CI: 50−105) mmHg;
P = 0.02), CPP (P = 0.01), and brain tissue oxygen tension (inflation: 315 (95%CI: 139−491)% of baseline;
sham: 204 (95%CI: 75−333)%; P = 0.04) were higher in the inflation compared to the sham group.
Conclusion
Inflation of REBOA in a porcine model of non-traumatic cardiac arrest improves central
diastolic arterial pressure as a surrogate marker of coronary artery pressure, and
cerebral perfusion.
Institutional protocol number
2017-15-0201-01371.
Keywords
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References
- Survival after out-of-hospital cardiac arrest in relation to sex: a nationwide registry-based study.Resuscitation. 2014; 85: 1212-1218https://doi.org/10.1016/j.resuscitation.2014.06.008
- Major changes in the 2005 AHA Guidelines for CPR and ECC: reaching the tipping point for change.Circulation. 2005; 112 (IV206–211)https://doi.org/10.1161/CIRCULATIONAHA.105.170809
- Bystander efforts and 1-year outcomes in out-of-hospital cardiac arrest.N Engl J Med. 2017; 376: 1737-1747https://doi.org/10.1056/NEJMoa1601891
- Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation.JAMA. 1990; 263: 1106-1113
- Inhibition of coronary blood flow by a vascular waterfall mechanism.Circ Res. 1975; 36: 753-760https://doi.org/10.1161/01.res.36.6.753
- Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme.BMJ Open. 2019; 9e027980https://doi.org/10.1136/bmjopen-2018-027980
- Feasibility of pre-hospital resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest.J Am Heart Assoc. 2019; 8e014394https://doi.org/10.1161/JAHA.119.014394
- Resuscitative endovascular balloon occlusion of the aorta for refractory out-of-hospital non-traumatic cardiac arrest — a case report.Prehosp Disaster Med. 2019; 34: 566-568https://doi.org/10.1017/S1049023X19004795
- Haemodynamic effects of descending aortic occlusion during cardiopulmonary resuscitation.Resuscitation. 1996; 33: 49-52https://doi.org/10.1016/s0300-9572(96)00992-6
- Intraaortic balloon occlusion during refractory cardiac arrest. A case report.Resuscitation. 2009; 80: 281-283https://doi.org/10.1016/j.resuscitation.2008.10.017
- Effect of intra-aortic occlusion balloon in external thoracic compressions during CPR in pigs.Am J Emerg Med. 2002; 20: 453-462https://doi.org/10.1053/ajem.2002.32627
- Improved cerebral blood supply and oxygenation by aortic balloon occlusion combined with intra-aortic vasopressin administration during experimental cardiopulmonary resuscitation.Acta Anaesthesiol Scand. 2000; 44: 1209-1219https://doi.org/10.1034/j.1399-6576.2000.441005.x
- Intra-aortic administration of epinephrine above an aortic balloon occlusion during experimental CPR does not further improve cerebral blood flow and oxygenation.Resuscitation. 2000; 44: 119-127https://doi.org/10.1016/s0300-9572(00)00132-5
- Improved haemodynamics and restoration of spontaneous circulation with constant aortic occlusion during experimental cardiopulmonary resuscitation.Resuscitation. 1999; 40: 171-180https://doi.org/10.1016/s0300-9572(99)00021-0
- Augmented efficacy of external CPR by intermittent occlusion of the ascending aorta.Circulation. 1993; 88: 1916-1921https://doi.org/10.1161/01.CIR.88.4.1916
- Effects of intra-aortic balloon occlusion on hemodynamics during, and survival after cardiopulmonary resuscitation in dogs.Crit Care Med. 1997; 25: 1003-1009https://doi.org/10.1097/00003246-199706000-00018
- Animal research: reporting in vivo experiments: the ARRIVE guidelines.Br J Pharmacol. 2010; 160: 1577-1579https://doi.org/10.1111/j.1476-5381.2010.00872.x
- Changes in cerebral blood flow and oxygen extraction during post-resuscitation syndrome.Resuscitation. 2008; 76: 17-24https://doi.org/10.1016/j.resuscitation.2007.06.028
- Technical recommendations for the use of carotid duplex ultrasound for the assessment of extracranial blood flow.Am J Physiol Regul Integr Comp Physiol. 2015; 309: R707-K720https://doi.org/10.1152/ajpregu.00211.2015
- Hemodynamics of cardiac arrest.Cardiac arrest: the science and practice of resuscitation medicine. 2007: 347-368https://doi.org/10.1017/CBO9780511544828.019
- When should clinicians act on non-statistically significant results from clinical trials?.JAMA. 2020; 380: 1397-1407https://doi.org/10.1001/jama.2020.3508
Sekhon MS, Ainslie PN, Griesdale DE. Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a “two-hit” model. n.d. https://doi.org/10.1186/s13054-017-1670-9.
- What comes first? The dynamics of cerebral oxygenation and blood flow in response to changes in arterial pressure and intracranial pressure after head injury.Br J Anaesth. 2012; 108: 89-99https://doi.org/10.1093/bja/aer324
- Transient changes in brain tissue oxygen in response to modifications of cerebral perfusion pressure: an observational study.Anesth Analg. 2010; 110: 165-173https://doi.org/10.1213/ANE.0b013e3181c0722f
- Cardiac output, oxygen consumption and arteriovenous oxygen difference following a sudden rise in exercise level in humans.J Physiol. 1991; 441: 501-512https://doi.org/10.1113/jphysiol.1991.sp018764
- Relationship of whole body oxygen consumption to perfusion flow rate during hypothermic cardiopulmonary bypass.J Thorac Cardiovasc Surg. 1982; 83: 239-248
- Extending the golden hour for Zone 1 resuscitative endovascular balloon occlusion of the aorta.J Trauma Acute Care Surg. 2018; 85https://doi.org/10.1097/TA.0000000000001964
- Emerging endovascular therapies for non-compressible torso hemorrhage.Shock. 2016; 46: 12-19https://doi.org/10.1097/SHK.0000000000000641
- Coronary perfusion pressure and return of spontaneous circulation after prolonged cardiac arrest.Prehosp Emerg Care. 2010; 14: 78-84https://doi.org/10.3109/10903120903349796
- Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association.Circulation. 2013; 128: 417-435https://doi.org/10.1161/CIR.0b013e31829d8654
- Cerebral blood flow regulation during hypoxia.Exp Physiol. 2015; 100: 109-110https://doi.org/10.1113/expphysiol.2014.084202
- Brain tissue oxygen tension response to induced hyperoxia reduced in hypoperfused brain.J Neurosurg. 2008; 108: 53-58https://doi.org/10.3171/JNS/2008/108/01/0053
- Arterial blood gases during and their dynamic changes after cardiopulmonary resuscitation: a prospective clinical study.Resuscitation. 2016; 106: 24-29https://doi.org/10.1016/j.resuscitation.2016.06.013
- Modes of induced cardiac arrest: hyperkalemia and hypocalcemia—literature review.Rev Bras Cir Cardiovasc. 2014; 29: 432-436https://doi.org/10.5935/1678-9741.20140074
- Intra-abdominal hypertension: a potent silent killer of cardiac arrest survivors.Am J Emerg Med. 2012; 30: 502-504https://doi.org/10.1016/j.ajem.2011.11.001
- Haemodynamics of cardiac arrest and resuscitation.Curr Opin Crit Care. 2006; 12: 198-203https://doi.org/10.1097/01.ccx.0000224861.70958.59
- Coronary blood flow during cardiopulmonary resuscitation in swine.Circulation. 1984; 69: 174-180https://doi.org/10.1161/01.cir.69.1.174
- Modeling cardiac arrest and resuscitation in the domestic pig.World J Crit Care Med. 2015; 4: 1-12https://doi.org/10.5492/wjccm.v4.i1.1
- Increased cortical cerebral blood flow with LUCAS; a new device for mechanical chest compressions compared to standard external compressions during experimental cardiopulmonary resuscitation.Resuscitation. 2005; 65: 357-363https://doi.org/10.1016/j.resuscitation.2004.12.006
- The effect of propofol on haemodynamics: cardiac output, venous return, mean systemic filling pressure, and vascular resistances.Br J Anaesth. 2016; 116: 784-789https://doi.org/10.1093/bja/aew126
Article info
Publication history
Published online: January 19, 2021
Accepted:
January 5,
2021
Received in revised form:
November 23,
2020
Received:
September 24,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
