Resuscitative Endovascular Balloon Occlusion of the Aorta for Refractory Out-of-Hospital Non-Traumatic Cardiac Arrest – A Case Report

Coniglio, Carlo; Gamberini, Lorenzo; Lupi, Cristian; Cavallo, Piergiorgio; Tartaglione, Marco; Chiarini, Valentina; Gordini, Giovanni

doi:10.1017/s1049023x19004795

Cited by 14 publications

(15 citation statements)

References 8 publications

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“…REBOA, by contrast, is lower cost and requires a skillset already mastered by emergency physicians. As demonstrated by Brede and Coniglio et al, REBOA may have a role in bridging patients to more advanced interventions such as ECMO, 19 an intra‐aortic balloon pump, 45 or cardiac catheterization.…”

Section: The Future Of Cardiac Arrestmentioning

confidence: 97%

“…In June 2019, Coniglio et al reported on the first case where a REBOA catheter was used in the emergency department for NTCA as a bridge therapy to an intra‐aortic balloon pump 45 . Following aortic balloon inflation in the ED, the patient's ETCO 2 increased from 8–20 mmHg, hemodynamics stabilized, and sustained ROSC was achieved.…”

Section: Reboa In Human Non‐traumatic Cardiac Arrestmentioning

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: The Future Of Cardiac Arrestmentioning

confidence: 97%

Section: Reboa In Human Non‐traumatic Cardiac Arrestmentioning

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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“…[10,11,18,21] Moreover, a few case reports have indicated that REBOA has an effect in humans with cardiac arrest. [22][23][24][25] Currently, there is only one report on the prospective clinical use of REBOA in the pre-hospital setting. [26] This study showed that pre-hospital REBOA procedure during resuscitation is feasible and did not negatively in uence the quality of ACLS.…”

Section: Study Rationalementioning

confidence: 99%

REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

Brede

Skulberg

Rehn

et al. 2021

Preprint

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Background Survival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports. Methods This multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 minutes. The secondary objectives of this trial are to measure 30-day survival with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events. Discussion Results from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort. Trial registration The trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.

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“…The studies also demonstrate increases in carotid artery blood flow [ 12 , 18 ], blood flow in the cerebral arteries [ 10 , 11 , 18 – 20 ], and cerebral perfusion pressure [ 10 , 11 , 18 , 21 ]. Moreover, a few case reports have indicated that REBOA has an effect in humans with cardiac arrest [ 22 – 25 ]. Currently, there is only one report on the prospective clinical use of REBOA in the pre-hospital setting [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

Brede

Skulberg

Rehn

et al. 2021

Trials

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Background Survival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports. Methods This multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 min. The secondary objectives of this trial are to measure the proportion of patients surviving to 30 days with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events. Discussion Results from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort. Trial registration The trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.

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Resuscitative Endovascular Balloon Occlusion of the Aorta for Refractory Out-of-Hospital Non-Traumatic Cardiac Arrest – A Case Report

Cited by 14 publications

References 8 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

REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

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