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

Craig D Nowadly, M Austin Johnson, Guillaume L Hoareau, James E Manning, James I Daley, Craig D Nowadly, M Austin Johnson, Guillaume L Hoareau, James E Manning, James I Daley

Abstract

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.

Keywords: arrhythmias cardiac; cardiopulmonary resuscitation; endovascular procedures; heart arrest; intra‐aortic balloon pumping; resuscitation; therapeutic occlusion.

Conflict of interest statement

Craig D. Nowadly. reports no conflict of interest. M. Austin Johnson. is a founder and stockholder of Certus Critical Care, Inc. Guillaume L. Hoareau. reports no conflict of interest. James E. Manning. is a co‐founder and stockholder of Resusitech, Inc. James I. Daley has received grant funding from Prytime Medical Devices Inc. and the American Heart Association.

© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.

Figures

FIGURE 1
FIGURE 1
Resuscitative endovascular balloon occlusion of the aorta (REBOA) placement during non‐traumatic cardiac arrest. The REBOA balloon is inflated in Zone 1 of the aorta, causing full aortic occlusion. This redirects the limited cardiac output generated during cardiopulmonary resuscitation towards the heart and brain, generating improved aortic pressure, coronary perfusion pressure, and cerebral perfusion
FIGURE 2
FIGURE 2
Resuscitative endovascular balloon occlusion of the aorta (REBOA) deployment in aorta Zone 1. Zone 1 aortic occlusion with REBOA allows for the cardiac output generated from cardiopulmonary resuscitation to be directed toward cardiac and cerebral vessels. As shown, higher aortic pressures improves flow to the coronary arteries and raises cerebral perfusion pressure

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