Abstract
Aims
Out of hospital cardiac arrest (OHCA) is still a leading cause of mortality worldwide.
In recent years, resuscitative endovascular balloon occlusion of the aorta (REBOA)
has been progressively studied as an adjunct to standard advanced life support (ALS)
in both traumatic and non-traumatic refractory OHCA.
Since January 2019, the REBOA procedure has been applied to all the patients experiencing
both traumatic and non-traumatic refractory OHCA (≥15 min of cardiopulmonary resuscitation)
not eligible for ECPR for clinical or logistic reasons.
We aimed at describing the feasibility and effects of REBOA performed both in the
Emergency Department and in the pre-hospital environment served by the local HEMS
for refractory OHCA.
Methods
Twenty consecutive patients experiencing refractory OHCA and in whom REBOA was attempted
in 2019 and 2020 were included in the study, Utstein data and REBOA specific variables
were recorded.
Results
Successful catheter placement was achieved in 18 out of 20 patients, 11 of these were
non-traumatic OHCAs while 7 were traumatic OHCAs, the 2 failures were related to repeated
arterial puncture failure.
Median time between the EMS dispatch and REBOA catheter placing attempt was 46 min.
An increase in etCO2 over 10 mmHg was observed after balloon inflation in 12 out of 18 patients (8/11
non-traumatic and 4/7 traumatic OHCAs), a sustained ROSC was observed in 5 patients
(1 traumatic and 4 non-traumatic OHCA) that were subsequently admitted to the ICU.
Four out of the 5 patients reached the criteria for brain death in the subsequent
24 h while one patient experienced another episode of refractory cardiac arrest in
ICU and subsequently died.
Conclusion
Our data confirm the feasibility of REBOA technique as an adjunct to ALS in both the
ED and prehospital phase and most of the treated patients experienced a transient
ROSC after balloon inflation while 5 out of 18 experienced a sustained ROSC.
However, while in the trauma setting increasing evidence suggests an improved survival
when REBOA is applied to refractory OHCA, in non-traumatic OHCA this has yet to be
demonstrated and large studies are needed.
Keywords
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Article info
Publication history
Published online: June 02, 2021
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© 2021 Elsevier B.V. All rights reserved.
