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Clinical paper| Volume 165, P161-169, August 2021

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Resuscitative endovascular occlusion of the aorta (REBOA) for refractory out of hospital cardiac arrest. An Utstein-based case series

      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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      References

        • Kiguchi T.
        • Okubo M.
        • Nishiyama C.
        • et al.
        Out-of-hospital cardiac arrest across the World: first report from the International Liaison Committee on Resuscitation (ILCOR).
        Resuscitation. 2020; 152: 39-49https://doi.org/10.1016/j.resuscitation.2020.02.044
        • Gräsner J.-T.
        • Herlitz J.
        • Tjelmeland I.B.M.
        • et al.
        European Resuscitation Council guidelines 2021: epidemiology of cardiac arrest in Europe.
        Resuscitation. 2021; 161: 61-79https://doi.org/10.1016/j.resuscitation.2021.02.007
        • Soar J.
        • Nolan J.P.
        • Böttiger B.W.
        • et al.
        European Resuscitation Council guidelines for resuscitation 2015. Section 3. Adult advanced life support.
        Resuscitation. 2015; 95: 100-147https://doi.org/10.1016/j.resuscitation.2015.07.016
        • Holmberg M.J.
        • Geri G.
        • Wiberg S.
        • et al.
        Extracorporeal cardiopulmonary resuscitation for cardiac arrest: a systematic review.
        Resuscitation. 2018; 131: 91-100https://doi.org/10.1016/j.resuscitation.2018.07.029
        • Kim S.J.
        • Kim H.J.
        • Lee H.Y.
        • Ahn H.S.
        • Lee S.W.
        Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: a meta-analysis.
        Resuscitation. 2016; 103: 106-116https://doi.org/10.1016/j.resuscitation.2016.01.019
        • Yamamoto R.
        • Suzuki M.
        • Funabiki T.
        • Nishida Y.
        • Maeshima K.
        • Sasaki J.
        Resuscitative endovascular balloon occlusion of the aorta and traumatic out‐of‐hospital cardiac arrest: a nationwide study.
        J Am Coll Emerg Physicians Open. 2020; 1: 624-632https://doi.org/10.1002/emp2.12177
        • Hilbert-Carius P.
        • McGreevy D.T.
        • Abu-Zidan F.M.
        • et al.
        Pre-hospital CPR and early REBOA in trauma patients-results from the ABOTrauma Registry.
        World J Emerg Surg. 2020; 15: 1-8https://doi.org/10.1186/s13017-020-00301-8
        • Brede J.R.
        • Lafrenz T.
        • Klepstad P.
        • et al.
        Feasibility of pre-hospital resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest.
        J Am Heart Assoc. 2019; 8: 1-8https://doi.org/10.1161/JAHA.119.014394
        • Levis A.
        • Greif R.
        • Hautz W.E.
        • et al.
        Resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiopulmonary resuscitation: a pilot study.
        Resuscitation. 2020; 156: 27-34https://doi.org/10.1016/j.resuscitation.2020.08.118
        • Coniglio C.
        • Gamberini L.
        • Lupi C.
        • et al.
        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
        • Brenner M.L.
        • Moore L.J.
        • DuBose J.J.
        • et al.
        A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation.
        J Trauma Acute Care Surg. 2013; 75: 506-511https://doi.org/10.1097/TA.0b013e31829e5416
        • Daley J.
        • Cannon K.
        • Buckley R.
        • et al.
        A research protocol and case report of emergency department endovascular aortic occlusion (Reboa) in non-traumatic cardiac arrest.
        J Endovasc Resusc Trauma Manag. 2020; 4: 88-93https://doi.org/10.26676/jevtm.v4i2.140
        • Nowadly C.D.
        • Johnson M.A.
        • Hoareau G.L.
        • Manning J.E.
        • Daley J.I.
        The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non‐traumatic cardiac arrest: a review.
        J Am Coll Emerg Physicians Open. 2020; 1: 737-743https://doi.org/10.1002/emp2.12241
        • Daley J.
        • Morrison J.J.
        • Sather J.
        • Hile L.
        The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest.
        Am J Emerg Med. 2017; 35: 731-736https://doi.org/10.1016/j.ajem.2017.01.010
        • Tibbits E.M.
        • Hoareau G.L.
        • Simon M.A.
        • et al.
        Location is everything: the hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta.
        J Trauma Acute Care Surg. 2018; 85: 101-107https://doi.org/10.1097/TA.0000000000001858
        • Dogan E.M.
        • Hörer T.M.
        • Edström M.
        • et al.
        Resuscitative endovascular balloon occlusion of the aorta in zone I versus zone III in a porcine model of non-traumatic cardiac arrest and cardiopulmonary resuscitation: a randomized study.
        Resuscitation. 2020; 151: 150-156https://doi.org/10.1016/j.resuscitation.2020.04.011
      1. UK-REBOA. n.d. (Accessed 11 April 2021, at https://w3.abdn.ac.uk/hsru/reboa/public/public/index.cshtml).

        • Brede J.R.
        • Lafrenz T.
        • Krüger A.J.
        • et al.
        Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme.
        BMJ Open. 2019; 9: 1-8https://doi.org/10.1136/bmjopen-2018-027980
        • Reynolds J.C.
        • Frisch A.
        • Rittenberger J.C.
        • Callaway C.W.
        Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies?.
        Circulation. 2013; 128: 2488-2494https://doi.org/10.1161/CIRCULATIONAHA.113.002408
        • Gamberini L.
        • Picoco C.
        • Del Giudice D.
        • et al.
        Improving the appropriateness of advanced life support teams’ dispatch: a before-after study.
        Prehosp Disaster Med. 2021; : 1-22https://doi.org/10.1017/s1049023x21000030
        • Nolan J.P.
        • Soar J.
        • Cariou A.
        • et al.
        European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015. Section 5 of the European Resuscitation Council guidelines for resuscitation 2015.
        Resuscitation. 2015; 95: 202-222https://doi.org/10.1016/j.resuscitation.2015.07.018
        • Evans C.
        • Quinlan D.O.
        • Engels P.T.
        • Sherbino J.
        Reanimating patients after traumatic cardiac arrest: a practical approach informed by best evidence.
        Emerg Med Clin North Am. 2018; 36: 19-40https://doi.org/10.1016/j.emc.2017.08.004
        • Truhlář A.
        • Deakin C.D.
        • Soar J.
        • et al.
        European Resuscitation Council guidelines for resuscitation 2015. Section 4. Cardiac arrest in special circumstances.
        Resuscitation. 2015; 95: 148-201https://doi.org/10.1016/j.resuscitation.2015.07.017
        • Perkins G.D.
        • Jacobs I.G.
        • Nadkarni V.M.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the international liaison committee.
        Circulation. 2015; 132: 1286-1300https://doi.org/10.1161/CIR.0000000000000144
        • Donnino M.W.
        • Andersen L.W.
        • Giberson T.
        • et al.
        Initial lactate and lactate change in post-cardiac arrest: a multi- center validation study Michael.
        Crit Care Med. 2015; 42: 1804-1811https://doi.org/10.1097/CCM.0000000000000332.Initial
        • Harhash A.A.
        • May T.L.
        • Hsu C.H.
        • et al.
        Risk stratification among survivors of cardiac arrest considered for coronary angiography.
        J Am Coll Cardiol. 2021; 77: 360-371https://doi.org/10.1016/j.jacc.2020.11.043
        • Wasicek P.J.
        • Yang S.
        • Teeter W.A.
        • et al.
        Traumatic cardiac arrest and resuscitative endovascular balloon occlusion of the aorta (REBOA): a preliminary analysis utilizing high fidelity invasive blood pressure recording and videography.
        Eur J Trauma Emerg Surg. 2019; 45: 1097-1105https://doi.org/10.1007/s00068-018-0989-5
        • Lendrum R.
        • Perkins Z.
        • Chana M.
        • et al.
        Pre-hospital resuscitative endovascular balloon occlusion of the aorta (REBOA) for exsanguinating pelvic haemorrhage.
        Resuscitation. 2019; 135: 6-13https://doi.org/10.1016/j.resuscitation.2018.12.018
        • Uchino H.
        • Tamura N.
        • Echigoya R.
        • Ikegami T.
        • Fukuoka T.
        REBOA—is it really safe? A case with massive intracranial hemorrhage possibly due to endovascular balloon occlusion of the aorta (REBOA).
        Am J Case Rep. 2016; 17: 810-813https://doi.org/10.12659/AJCR.900267
        • Bailey Z.S.
        • Cardiff K.
        • Yang X.
        • et al.
        The effects of balloon occlusion of the aorta on cerebral blood flow, intracranial pressure, and brain tissue oxygen tension in a rodent model of penetrating ballistic-like brain injury.
        Front Neurol. 2019; 10: 1-11https://doi.org/10.3389/fneur.2019.01309
        • Williams A.M.
        • Bhatti U.F.
        • Dennahy I.S.
        • et al.
        Traumatic brain injury may worsen clinical outcomes after prolonged partial resuscitative endovascular balloon occlusion of the aorta in severe hemorrhagic shock model.
        J Trauma Acute Care Surg. 2019; 86: 415-423https://doi.org/10.1097/TA.0000000000002149
        • Johnson M.A.
        • Williams T.K.
        • Ferencz S.A.E.
        • et al.
        The effect of resuscitative endovascular balloon occlusion of the aorta, partial aortic occlusion and aggressive blood transfusion on traumatic brain injury in a swine multiple injuries model.
        J Trauma Acute Care Surg. 2017; 83 (Lippincott Williams and Wilkins): 61-70https://doi.org/10.1097/TA.0000000000001518
        • Elkbuli A.
        • Kinslow K.
        • Sen-Crowe B.
        • Liu H.
        • McKenney M.
        • Ang D.
        Outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) utilization in trauma patients with and without traumatic brain injuries: a national analysis of the American College of Surgeons Trauma Quality Improvement Program data set.
        Surgery. 2021; (S0039-6060(21)00081-7, Epub ahead of print. PMID: 33676729)https://doi.org/10.1016/j.surg.2021.01.043
        • Chevret S.
        • Escutnaire J.
        • Guenin A.
        • Hoogvorst A.
        • Reuter P.G.
        Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients.
        Resuscitation. 2017; 111: 74-81https://doi.org/10.1016/j.resuscitation.2016.11.024
        • Nolan J.P.
        • Sandroni C.
        • Böttiger B.W.
        • et al.
        European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care.
        Intensive Care Med. 2021; 47: 369-421https://doi.org/10.1007/s00134-021-06368-4