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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 10 min of skin disinfection. Secondary outcomes included perfusion markers (mean central arterial blood pressure, end-tidal CO 2 , 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 9 min 30 s). Median interval from dispatch to start of the procedure was 59 min. A small, albeit significant increase in non-invasively measured cerebral oxygenation was found, but none in blood pressure or end-tidal CO 2 . However, two patients with pulseless electrical activity of more than 20 min 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.

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BackgroundThe purpose of this study was to survey the current practice of the use of lung ultrasonography (LUS) in the diagnosis of pneumothorax.MethodsPhysician sonographers, accredited for diagnostic ultrasonography in surgery, anaesthesia and medicine were studied. Questions addressed the frequency of exposure to patients with suspected pneumothorax, frequency of LUS use, preferences regarding technical aspects of LUS examination, assessment of diagnostic accuracy of LUS and involvement in teaching.ResultsOf the respondents, 55.1% used LUS ‘always’ or ‘frequently’ for suspected pneumothorax. Also, 35.5% of physicians rated LUS as ‘always reliable’ in ruling out pneumothorax, and 21.3% of respondents rated LUS as ‘always reliable’ in ruling in pneumothorax. The mode of performing LUS for pneumothorax was highly variable.Statistically significant differences were found regarding the likelihood of LUS usage, the combined use of M-Mode and B-mode scanning and the confidence to exclude pneumothorax based on LUS findings for physicians with frequent exposure to pneumothorax cases.ConclusionsPhysicians' use of LUS in the diagnosis of pneumothorax is modest. Confidence in diagnostic accuracy is not comprehensive. Further research is required to establish the most efficient way of performing LUS in this scenario to achieve the highest possible diagnostic accuracy and reliable documentation of examination results.