Resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiopulmonary resuscitation: A pilot study

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 CO₂, 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 CO₂. 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.