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

Gamberini, Lorenzo; Coniglio, Carlo; Lupi, Cristian; Tartaglione, Marco; Mazzoli, Carlo Alberto; Baldazzi, Marzia; Cecchi, Alessandra; Ferri, Enrico; Chiarini, Valentina; Semeraro, Federico; Gordini, Giovanni

doi:10.1016/j.resuscitation.2021.05.019

Cited by 29 publications

(42 citation statements)

References 32 publications

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“…Only one study by Gaspary et al [23] reported on the effectiveness during transport of JTQ application in a pre-hospital environment. Whilst other studies mentioned devices remaining in place during transport [29][30][31][37][38][39], it was not specifically assessed. An in-hospital case report by Croushorn et al [40] reported that the AAJT remained in place during transport from the emergency department to the operating theatre with no blood loss seen throughout transfer.…”

Section: Discussionmentioning

confidence: 99%

“…Of the eight studies that investigated the use of REBOA in a pre-hospital setting, four were case series and reports of military patients [12,[33][34][35], and four were case series and reports of civilian patients [36][37][38][39] (Table 6). Studies reported whether REBOA was deployed in zone 1 (n = 3), zone 3 (n = 2), or a variation of zone 1 or 3 dependent on injury location (n = 3).…”

Section: Pre-hospital Evidencementioning

confidence: 99%

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Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

2022

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Catastrophic haemorrhage accounts for up to 40% of global trauma related mortality and is the leading cause of preventable deaths on the battlefield. Controlling abdominal and junctional haemorrhage is challenging, especially in the pre-hospital setting or ‘under fire’, yet there is no haemostatic agent which satisfies the seven characteristics of an ‘ideal haemostat’. We conducted a systematic search of Embase, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to evaluate the feasibility and efficacy of three types of haemostatic devices. Participants included any trauma patient in a pre-hospital setting, perfused human cadavers, or healthy human volunteer simulations. The haemostatic devices reviewed were REBOA, iTClampTM, and four junctional tourniquets: AAJT, CRoC, JETT, and SJT. The SJT had the best user survey performance of the junctional tourniquets, and the four junctional tourniquets had an overall efficacy of 26.6–100% and an application time of 10–203 s. The iTClampTM had an efficacy of 60–100% and an application time of 10–60 s. REBOA had an efficacy of 71–100% and an application time ranging from 5 min to >80 min. In civilian and military trauma patients the use of junctional tourniquets, iTClamp, or REBOA, mortality varied from 0–100%. All of these studies were deemed low to very low in quality, hence the reliability of data presented in each of the studies is called into question. We conclude that despite limited data for these devices, their use in the pre-hospital environment or ‘under fire’ is feasible with the correct training, portable imaging, and patient selection algorithms. However, higher quality studies are required to confirm the true efficacy of these devices.

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Section: Discussionmentioning

confidence: 99%

Section: Pre-hospital Evidencementioning

confidence: 99%

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

2022

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“…Our study group recently published a prospective cohort study [10] on 20 patients with traumatic and non-traumatic cardiac arrest in whom REBOA was used as an adjunctive treatment. The results confirmed the increase in etCO 2 after balloon inflation, and a potential benefit in terms of odds of ROSC in a group of patients not eligible for ECLS.…”

Section: Reboa In Non-traumatic Cardiac Arrestmentioning

confidence: 99%

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Non-Traumatic Cardiac Arrest: A Narrative Review of Known and Potential Physiological Effects

Mazzoli

Chiarini

Coniglio

et al. 2022

JCM

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is widely used in acute trauma care worldwide and has recently been proposed as an adjunct to standard treatments during cardiopulmonary resuscitation in patients with non-traumatic cardiac arrest (NTCA). Several case series have been published highlighting promising results, and further trials are starting. REBOA during CPR increases cerebral and coronary perfusion pressure by increasing the afterload of the left ventricle, thus improving the chances of ROSC and decreasing hypoperfusion to the brain. In addition, it may facilitate the termination of malignant arrhythmias by stimulating baroreceptor reflex. Aortic occlusion could mitigate the detrimental neurological effects of adrenaline, not only by increasing cerebral perfusion but also reducing the blood dilution of the drug, allowing the use of lower doses. Finally, the use of a catheter could allow more precise hemodynamic monitoring during CPR and a faster transition to ECPR. In conclusion, REBOA in NTCA is a feasible technique also in the prehospital setting, and its use deserves further studies, especially in terms of survival and good neurological outcome, particularly in resource-limited settings.

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“…One of the key challenges of REBOA in patients in TCA is the cannulation of the common femoral artery. Although previous studies have shown the feasibility of intra-arrest cannulation in patients who had suffered a medical arrest [ 36 – 38 ], cannulation may be more challenging in significantly hypovolemic patients, even when using ultrasound. Surgical cut-down to expose the femoral vessels may be considered by proficient providers to facilitate cannulation in this instance [ 39 ].…”

Section: Patients In Traumatic Cardiac Arrestmentioning

confidence: 99%

Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

et al. 2022

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Early haemorrhage control and minimizing the time to definitive care have long been the cornerstones of therapy for patients exsanguinating from non-compressible haemorrhage (NCH) after penetrating injuries, as only basic treatment could be provided on scene. However, more recently, advanced on-scene treatments such as the transfusion of blood products, resuscitative thoracotomy (RT) and resuscitative endovascular balloon occlusion of the aorta (REBOA) have become available in a small number of pre-hospital critical care teams. Although these advanced techniques are included in the current traumatic cardiac arrest algorithm of the European Resuscitation Council (ERC), published in 2021, clear guidance on the practical application of these techniques in the pre-hospital setting is scarce. This paper provides a scoping review on how these advanced techniques can be incorporated into practice for the resuscitation of patients exsanguinating from NCH after penetrating injuries, based on available literature and the collective experience of several helicopter emergency medical services (HEMS) across Europe who have introduced these advanced resuscitation interventions into routine practice. Graphical Abstract

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

Cited by 29 publications

References 32 publications

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

Use of Haemostatic Devices for the Control of Junctional and Abdominal Traumatic Haemorrhage: A Systematic Review

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Non-Traumatic Cardiac Arrest: A Narrative Review of Known and Potential Physiological Effects

Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

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