A Research Protocol and Case Report of Emergency Department Endovascular Aortic Occlusion (REBOA) in Non-traumatic Cardiac Arrest

Authors

  • James Ian Daley Yale School of Medicine
  • Kathryn Cannon Yale School of Medicine
  • Ryan Buckley Yale School of Medicine
  • Ani Aydin Yale School of Medicine
  • Igor Latich Yale School of Medicine
  • Juan Carlos Perez Lozada Yale School of Medicine
  • James Bonz Yale School of Medicine
  • Daniel Joseph Yale School of Medicine
  • Ryan Coughlin Yale School of Medicine
  • Justin Belsky Yale School of Medicine
  • John Sather Yale School of Medicine
  • Charles Wira Yale School of Medicine
  • Rachel Liu Yale School of Medicine
  • Austin Johnson Yale School of Medicine
  • Christopher Moore Yale School of Medicine

DOI:

https://doi.org/10.26676/jevtm.v40i(2).140

Keywords:

REBOA, resuscitation, aortic occlusion, cardiac arrest, out-of-hospital cardiac arrest, non-traumatic cardiac arrest, resuscitative endovascular balloon occlusion of the aorta

Abstract

Background

There are over 395,000 out-of-hospital cardiac arrests (OHCA) annually in the United States with an estimated 70-90% mortality rate and fewer than 10% surviving with a favorable neurologic outcome. Research in animal models and early human studies suggests that REBOA may play a role in augmenting coronary perfusion during OHCA by reducing blood flow to the lower body and re-directing it towards the heart and brain. We describe our initial case and research protocol to investigate the feasibility of REBOA in the emergency department (ED) for OHCA as an adjunct to ACLS.

Methods

We plan to enroll twenty patients in a single-arm interventional device study utilizing an exception from informed consent over a two-year period. The primary outcome is feasibility, with secondary outcomes assessing for hemodynamic changes pre- and post-aortic occlusion.

Results

Enrollment began in January 2020 and is ongoing. For the initial patient, an EP obtained ultrasound guided common femoral arterial access under chest compressions, followed by advancement of the REBOA catheter by an interventional radiologist. Immediately after aortic occlusion, investigators noted a substantial improvement in mean arterial pressure (MAP) (37 mmHg to 50 mmHg) and end tidal carbon dioxide (ETCO2) (33 mmHg to 50 mmHg), with transient but non-sustained return of spontaneous circulation (ROSC).

Conclusion

This is the first research protocol and case report of ED-REBOA initiation involving emergency physicians (EP) for non-traumatic OHCA. We describe our research protocol and initial case of a patient in OHCA who and underwent successful REBOA placement in the ED as an adjunct to ACLS.

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Published

2020-11-29

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Section

Original Article