Prehospital endovascular occlusion of the aorta is now a technically feasible strategy for improving haemodynamics in CPR

Foerster, Christopher R.; Turgulov, Anuar

doi:10.1016/j.resuscitation.2015.05.018

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…As shown, higher aortic pressures improves flow to the coronary arteries and raises cerebral perfusion pressure catheters (>8 Fr), vascular repair may be required once removed, although this is much less likely for smaller catheters. 30…”

Section: F I G U R Ementioning

confidence: 99%

“…After the catheter is removed, the arterial introducer sheath may be used for arterial pressure monitoring and cardiac catheterization or upsized for extracorporeal membrane oxygenation (ECMO). For large REBOA catheters (>8 Fr), vascular repair may be required once removed, although this is much less likely for smaller catheters 30 …”

Section: Reboa Deployment During Cprmentioning

confidence: 99%

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The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non‐traumatic cardiac arrest: A review

et al. 2020

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been proposed as a novel approach to managing non‐traumatic cardiac arrest (NTCA). During cardiac arrest, cardiac output ceases and perfusion of vital organs is compromised. Traditional advanced cardiac life support (ACLS) measures and cardiopulmonary resuscitation are often unable to achieve return of spontaneous circulation (ROSC). During insertion of REBOA a balloon‐tipped catheter is placed into the femoral artery and advanced in a retrograde manner into the aorta while the patient is undergoing cardiopulmonary resuscitation (CPR). The balloon is then inflated to fully occlude the aorta. The literature surrounding the use of aortic occlusion in non‐traumatic cardiac arrest is limited to animal studies, case reports and one recent non‐controlled feasibility trial. In both human and animal studies, preliminary data show that REBOA may improve coronary and cerebral perfusion pressures and key physiologic parameters during cardiac arrest resuscitation, and animal data have demonstrated improved rates of ROSC. Multiple questions remain before REBOA can be considered as an adjunct to ACLS. If demonstrated to be effective clinically, REBOA represents a potentially cost‐effective and generalizable intervention that may improve quality of life for patients with non‐traumatic cardiac arrest.

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Section: F I G U R Ementioning

confidence: 99%

Section: Reboa Deployment During Cprmentioning

confidence: 99%

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non‐traumatic cardiac arrest: A review

et al. 2020

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“…Szükség lenne ezen centrumok eszközös felszerelésére és megfelelő oktatással használatuk elsajátítására (2,3). Többek között azért is lenne logikus lépés a szívsebészeti centrumokban történő ECMO-rendszer felépítése, mivel ezek a centrumok találkoznak első körben akut miokardiális infarktus mechanikus szövődményeivel (VSD), vagy pedig a szívműtét után kialakuló akár 2-6% prevalenciájú postcardiotomiás szindrómával (4,5). További széles körű alkalmazási területe lenne az ECMO-terápiának az akut miokardiális infarktushoz társuló akut balszívfél-elégtelenség.…”

Section: Megbeszélésunclassified

A mechanikus keringéstámogatás helyzete Magyarországon a Városmajor eredményeinek tükrében

Hartyánszky¹,

Sax²,

Fazekas³

et al. 2017

Cardiologia Hungarica

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A 25 éves magyar szívtranszplantáció sikertörténete mellé az elmúlt 5 évben felépítettük és programmá fejlesztettük a mechanikus keringéstámogatás terápiáját. Az elmúlt 5 évben történt fejlesztések, a Semmelweis Egyetem Városmajori Szív-és Érgyógyászati Klinikáján megépített Szívtranszplantációs és Szívelégtelenségi Intenzív Osztály, eszköz-és humánerőforrás fejlesztések tették lehetővé programunk kiteljesedését. Ma már a teljes mechanikus keringéstámogatási arzenállal, műszerparkkal rendelkezünk, amelynek segítségével minden indikációban és minden stratégiában ellátást tudunk nyújtani mind rövid, mind közép-, mint hosszú távon, akár a végleges műszív beültetésig. Klinikánkon az elmúlt 5 évben 140 beteget kezeltünk összesen 185 esetben mechanikus keringéstámogató eszközökkel, valamennyi esetben súlyos terápia refrakter szívelégtelenségben: 50 alkalommal szívátültetés utáni primer graft-elégtelenség, 64 esetben krónikus végstádiumú szívelégtelenség akut exacerbációja, 41 esetben akut miokardiális infarktus okozta szívelégtelenség, 25 esetben szívműtét utáni postcardiotomiás szindróma, 4 esetben súlyos légzési elégtelenség, 1 esetben gyógyszer-intoxikáció miatt kialakult malignus kamrai ritmuszavar miatt alkalmaztuk a terápiát. A rövid és középtávú eszközök alkalmazásával a terápia refrakter kardiogén sokkban lévő betegek nagyobbik részét sikeresen juttattuk el a gyógyulásig vagy szívátültetésig, néhány esetben hosszú távú eszköz beültetéséig. 28 betegnél hosszú távú bal kamrát támogató eszközt ültettünk be a szívtranszplantációig történő áthidaló kezelésként, kiváló túléléssel. State of the art of the mechanical circulatory device therapy in Hungary-the Városmajor experience Parallel to the 25 years of success in the Hungarian transplant program, in the last 5 years we built up a comprehensive mechanical circulatory support (MCS) program. Infrastructural and human resource development at the Heart and Vascular Center of Semmelweis University-including the establishment of a dedicated intensive care unit for heart failure therapies and heart transplantation-made the success of our advanced heart failure therapies program available. Now we provide the full spectrum of mechanical circulatory support in all indications and bridging strategies including short, mid and long term support. In the last fi ve years, we treated 140 patients with severe heart failure refractory to medical therapy with a total of 185 device implantations. Indications were primary graft failure after cardiac transplant (n=50), acute decompensation of chronic heart failure (n=64), post-myocardial infarction cardiogenic shock (n=41), post-cardiotomy syndrome (n=25), severe respiratory insuffi ciency (n=4) and drug toxicity induced ventricular tachyarrhythmia (n=1). We were able to bridge the majority of these patients to recovery, heart transplant or in certain cases until upgraded MCS therapy. We implanted 26 long term device as a bridge to transplant strategy with excellent results.

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“…Moreover, the inflation of the REBOA increases cerebral perfusion pressure (CePP) [12] as well as carotid blood flow [11] when combined to epinephrine. However, although clinical data are emerging, showing the feasibility of REBOA implementation during CPR [13], even in the prehospital setting [14], the effect of REBOA has not been considered as a sole replacement therapy during non-traumatic CA. Accordingly, the goal of this study was to determine whether the effect of REBOA during CPR on cardiac afterload could be used as a substitute for epinephrine administration in non-traumatic CA, to obtain ROSC while avoiding deleterious effects of epinephrine on cerebral microcirculation.…”

Section: Introductionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine

Hutin

Levy

Lidouren

et al. 2021

Ann. Intensive Care

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Background The administration of epinephrine in the management of non-traumatic cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during cardiopulmonary resuscitation (CPR) in a swine model of non-traumatic cardiac arrest. Results Anesthetized pigs were instrumented and submitted to ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical CPR device, animals were randomly submitted to either REBOA or epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After resuscitation, CBF remained lower in the epinephrine group as compared to REBOA, but it did not achieve statistical significance. Conclusions During CPR, REBOA is as efficient as epinephrine to facilitate ROSC. Unlike epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic cardiac arrest.

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Prehospital endovascular occlusion of the aorta is now a technically feasible strategy for improving haemodynamics in CPR

Cited by 6 publications

References 5 publications

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non‐traumatic cardiac arrest: A review

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non‐traumatic cardiac arrest: A review

A mechanikus keringéstámogatás helyzete Magyarországon a Városmajor eredményeinek tükrében

Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine

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