Use of resuscitative balloon occlusion of the aorta in a swine model of prolonged cardiac arrest

Tiba, Mohamad H.; McCracken, Brendan; Cummings, Brandon C; Colmenero, Carmen I; Rygalski, Chandler J.; Hsu, Cindy H.; Sanderson, Thomas H.; Nallamothu, Brahmajee K.; Neumar, Robert W.; Ward, Kevin R.

doi:10.1016/j.resuscitation.2019.05.010

Cited by 26 publications

(20 citation statements)

References 28 publications

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“…3). It should be considered that CPR itself is a powerful predictor of death, and REBOA is being implemented to buy time for the next treatment in patients with a high risk of death [9,22,23]. Therefore, further research with more accumulated data is necessary.…”

Section: Discussionmentioning

confidence: 99%

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study

Park

Jang

et al. 2020

J Trauma Inj

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Purpose: This retrospective multicenter study analyzed trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) in the Republic of Korea. methods: This study was conducted from February 2017 to May 2018 at three regional trauma centers in the Republic of Korea. The patients were divided into two groups (cardiopulmonary resuscitation [CPR] and No-CPR) for comparative analysis based on two criteria (complication and mortality) for logistic regression analysis (LRA). results: There were significant differences between the CPR and No-CPR groups in mortality (p=0.003) and treatment administered (p=0.016). By LRA for complications, total occlusion has significantly lesser risk than intermittent or partial occlusion in both univariate (odds ratio [OR] 0.06, 95% confidence interval [CI] 0.00-0.36, p=0.01) and multivariate (OR 0.05, 95% CI 0.00-0.38, p=0.01) analyses. The Rescue had a higher risk than the Coda or Reliant in univariate analysis (OR 4.91, 95% CI 1.14-34.25, p=0.05); however, it was not statistically significant in multivariate analysis (OR 6.98, 95% CI 1.03-74.52, p=0.07). By LRA for mortality, the CPR group was the only variable that had a significantly higher risk of mortality than the No-CPR group in both univariate (OR 17.59, 95% CI 3.05-335.25, p=0.01), and multivariate (OR 24.92, 95% CI 3.77-520.51, p=0.01) analyses. Conclusions: This study was conducted in the early stages of REBOA implementation in the Republic of Korea and showed conflicting results from studies conducted by multiple institutions. Therefore, additional research with more accumulated data is needed.

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Section: Discussionmentioning

confidence: 99%

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study

Park

Jang

et al. 2020

J Trauma Inj

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“…REBOA's role is to buy the time to allow for subsequent treatment, such as surgery or angiographic embolization. For patients with a high risk of death [3,23,24], it is very important to implement REBOA accurately and concisely, to reduce the patient's hemorrhagic burden even a little. Many studies have shown that a catheter with a smaller diameter is more favorable for patient safety compared to larger catheters [16,17].…”

Section: Discussionmentioning

confidence: 99%

Pitfalls, Complications, and Necessity of Education about REBOA: A Single Regional Trauma Center Study

et al. 2020

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Purpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure and extremely time-dependent, and the proficiency of the physician is important. Due to a lack of REBOA education programs in Republic of Korea, few physicians have been trained in the procedure. In this study, we examined how RE-BOA education affects clinical outcomes in a single center. methods: A retrospective study conducted from February 2017 to June 2020 at a regional trauma center. We collected data of patients who underwent REBOA and analyzed the factors that influenced the outcome. The patients were divided into the educated and non-educated groups (based on REBOA training received by their physicians), and the success and failure groups. results: A total of 24 patients underwent REBOA during the study. There were eight patients in the success group and 16 patients in the failure group. There are no significant differences between the educated and non-educated groups in sex, age, ISS, shock, injury-to-REBOA time, injury mechanism, injury sites, arrest, access site, type of catheter, type of REBOA, target Zone, mortality, and the result of REBOA. The non-educated group had a higher risk for failure compared to the educated group in multivariate analysis (odds ratio [OR] 154.64, 95% confidence interval [CI] 1.11-22.60). Conclusions: Failure in REBOA is harmful to patients. The risk of failure is increased in the non-educated group. Physicians working in the trauma center or emergency department need to complete the REBOA education program.

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“…32,33 Multiple studies have shown thoracic aortic occlusion improves cerebral and coronary perfusion pressures, coronary blood flow, end-tidal carbon dioxide, and overall mortality. 32,[34][35][36][37][38][39] In one notable study of adult swine, during alternating periods of intra-aortic balloon inflation and deflation, balloon inflation increased CPP by an average of 13.7 mmHg (60%) and coronary blood flow increased by 15.5 mL/min (8.5%). 35 placement.…”

Section: Reboa In Animal Non-traumatic Cardiac Arrestmentioning

confidence: 99%

“…32,[34][35][36][37][38][39] In one notable study of adult swine, during alternating periods of intra-aortic balloon inflation and deflation, balloon inflation increased CPP by an average of 13.7 mmHg (60%) and coronary blood flow increased by 15.5 mL/min (8.5%). 35 placement. 41,42 Although Zone 3 occlusion would benefit visceral perfusion and possibly prevent ischemic injury, any hemodynamic benefit was transient or did not translate to improved outcomes.…”

Section: Reboa In Animal 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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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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Use of resuscitative balloon occlusion of the aorta in a swine model of prolonged cardiac arrest

Cited by 26 publications

References 28 publications

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study

Pitfalls, Complications, and Necessity of Education about REBOA: A Single Regional Trauma Center Study

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

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