Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine

Alice Hutin, Yaël Levy, Fanny Lidouren, Matthias Kohlhauer, Pierre Carli, Bijan Ghaleh, Lionel Lamhaut, Renaud Tissier, Alice Hutin, Yaël Levy, Fanny Lidouren, Matthias Kohlhauer, Pierre Carli, Bijan Ghaleh, Lionel Lamhaut, Renaud Tissier

Abstract

Background: The administration of epinephrine in the management of non-traumatic cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during cardiopulmonary resuscitation (CPR) in a swine model of non-traumatic cardiac arrest.

Results: Anesthetized pigs were instrumented and submitted to ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical CPR device, animals were randomly submitted to either REBOA or epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After resuscitation, CBF remained lower in the epinephrine group as compared to REBOA, but it did not achieve statistical significance.

Conclusions: During CPR, REBOA is as efficient as epinephrine to facilitate ROSC. Unlike epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic cardiac arrest.

Keywords: Cardiac arrest; Epinephrine; Resuscitative endovascular balloon occlusion of the aorta.

Conflict of interest statement

M Kohlhauer and R Tissier are shareholders of a start-up company dedicated to total liquid ventilation (Orixha).

Figures

Fig. 1
Fig. 1
Typical waveforms of hemodynamic parameters, heart rate, mean arterial and coronary perfusion pressure. a Experimental protocol and typical hemodynamic tracings in two animals before and after either epinephrine (EPI, upper panel) administration or resuscitative endovascular balloon occlusion of the aorta (REBOA, lower panel), respectively. b Heart rate, mean arterial pressure and coronary perfusion pressure during the protocol (i.e., at baseline, during CPR and after ROSC). N = 6 in both groups; CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation
Fig. 2
Fig. 2
Carotid blood flow, cerebral vascular resistance, cerebral perfusion pressure, mean intracranial pressure, cerebral regional oxygen saturation and end-tidal CO2 throughout experimental protocol. * P < 0.05 between EPI and REBOA group; CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation. N = 6 in both groups, except for cerebral oximetry, which was only available in 5 animals in the Epi vs 6 in the REBOA group, respectively. Statistical comparisons were only made at each time-point between groups, but not between time-points
Fig. 3
Fig. 3
Blood gases and lactates blood levels throughout experimental protocol. N = 6 in both groups; * P < 0.05 between EPI and REBOA group; CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation. Statistical comparisons were only made at each time-point between groups, but not between time-points

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