Abstract 357: Resuscitative Balloon Occlusion of the Aorta in Non-Traumatic out of Hospital Cardiac Arrest - Evaluation of an Educational Program

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jostein Rødseth Brede ◽  
Thomas Lafrenz ◽  
Andreas Jørstad Kruger ◽  
Edmund Søvik ◽  
Torjus Steffensen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Critical Incident ◽  
Life Support ◽  
Objective Assessment ◽  
Balloon Occlusion ◽  
Assessment Scores ◽  
Thoracic Level ◽  
Standard Quality ◽  
Prehospital Emergency ◽  
Hospital Cardiac Arrest

Background: Out of hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation and hence oxygen delivery to vital organs such as the brain and heart during cardio-pulmonal resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data supports that patients in non-traumatic CA might benefit from REBOA placed in the thoracic level during CPR. Methods: We developed a REBOA team-based training program involving the physicians and prehospital emergency medical service (P-EMS) operators working on the National Air Ambulance helicopter base in Trondheim, Norway. The program consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application (OSAPRA) scoring chart and a special designed training dummy was made for this study. Results: 7 physicians and 3 P-EMS operators participated. The time needed to perform the REBOA procedure was 8,5 min (range; 6,3 - 12,7). The corresponding time from arrival at scene to balloon inflation was 12,0 min (range; 8,8 - 15). The total objective assessment scores of the candidates’ competency was 41,8 points out of 48 (range; 39 - 43,5). The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure. Conclusions: This four-step approach to educate, train and implement the REBOA technique to a prehospital working team is feasible and provides adequate competence. In a simulated setting the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS.

scholarly journals Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027980 ◽  
Author(s):  
Jostein Rødseth Brede ◽  
Thomas Lafrenz ◽  
Andreas J Krüger ◽  
Edmund Søvik ◽  
Torjus Steffensen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Critical Incident ◽  
Life Support ◽  
Objective Assessment ◽  
Training Programme ◽  
Educational Programme ◽  
Balloon Occlusion ◽  
Thoracic Level ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

BackgroundOut-of-hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation during cardiopulmonary resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data support that patients in non-traumatic cardiac arrest might benefit from REBOA in the thoracic level during CPR. This study describes a training programme to implement the REBOA procedure to a prehospital working team, in preparation to a planned clinical study.MethodsWe developed a team-based REBOA training programme involving the physicians and paramedics working on the National Air Ambulance helicopter base in Trondheim, Norway. The programme consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application scoring chart and a special designed simulation mannequin was made for this study.ResultsSeven physicians and 3 paramedics participated. The time needed to perform the REBOA procedure was 8.5 (6.3–12.7) min. The corresponding time from arrival at scene to balloon inflation was 12.0 (8.8–15) min. The total objective assessment scores of the candidates’ competency was 41.8 (39–43.5) points out of 48. The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure.ConclusionThis four-step approach to educate, train and implement the REBOA procedure to a prehospital working team ensures adequate competence in a simulated OHCA setting. The use of a structured training programme and objective assessment of skills is recommended before utilising the procedure in a clinical setting. In a simulated setting, the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS.Trial registration numberNCT03534011.

scholarly journals Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Charles Payot ◽  
Christophe A Fehlmann ◽  
Laurent Suppan ◽  
Marc Niquille ◽  
Christelle Lardi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Multivariable Logistic Regression Model ◽  
Physician Decision Making ◽  
Factors Influencing ◽  
Cardio Pulmonary Resuscitation ◽  
Prehospital Emergency ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

scholarly journals REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jostein Rødseth Brede ◽  
Arne Kristian Skulberg ◽  
Marius Rehn ◽  
Kjetil Thorsen ◽  
Pål Klepstad ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Multicentre Trial ◽  
Life Support ◽  
Intervention Group ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Adjunctive Treatment ◽  
Control Group ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Abstract Background Survival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports. Methods This multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 min. The secondary objectives of this trial are to measure the proportion of patients surviving to 30 days with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events. Discussion Results from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort. Trial registration The trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.

scholarly journals Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

2021 ◽  
Vol 18 (16) ◽  
pp. 8323
Author(s):  
Charles Payot ◽  
Christophe A. Fehlmann ◽  
Laurent Suppan ◽  
Marc Niquille ◽  
Christelle Lardi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Multivariable Logistic Regression Model ◽  
Physician Decision Making ◽  
Factors Influencing ◽  
Prehospital Emergency ◽  
Bystander Cpr ◽  
Comorbidity Index ◽  
Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

Non-Occlusive Mesenteric Ischemia After Resuscitative Endovascular Balloon Occlusion of the Aorta for Out-of-Hospital Cardiac Arrest due to Massive Gastrointestinal Bleeding

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Shinsuke Tanizaki ◽  
Takeo Matsumoto ◽  
Misaki Murasaki ◽  
Minoru Hayashi ◽  
Shigenobu Maeda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mesenteric Ischemia ◽  
Life Support ◽  
Ischemia Reperfusion ◽  
Balloon Occlusion ◽  
Low Flow ◽  
Massive Gastrointestinal Bleeding ◽  
Occlusive Mesenteric Ischemia ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a method of controlling intra-abdominal bleeding in case of hemorrhagic shock and an adjunct to improve traditional advanced cardiac life support in nontraumatic cardiac arrest. Partial REBOA is proposed as an alternative method that regulates low volume continuous blood flow across the area of occlusion with the aim of minimizing ischemia-reperfusion injury. Case Presentation: An 82-year-old male suffered an out-of-hospital cardiac arrest due to massive gastric bleeding. He was initially resuscitated with partial REBOA but died of non-occlusive mesenteric ischemia (NOMI). The possible causes of NOMI were the patient’s age, the low flow state with prolonged cardiopulmonary resuscitation, the lower proximal-to-distal gradient of partial REBOA, and the longer time of total occlusion. Conclusion: Further studies may be required to determine the optimal distal pressure during partial REBOA to limit the burden of mesenteric ischemia.

scholarly journals Non-Occlusive Mesenteric Ischemia After Resuscitative Endovascular Balloon Occlusion of the Aorta for Out-of-Hospital Cardiac Arrest due to Massive Gastrointestinal Bleeding

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Shinsuke Tanizaki ◽  
Takeo Matsumoto ◽  
Misaki Murasaki ◽  
Minoru Hayashi ◽  
Shigenobu Maeda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mesenteric Ischemia ◽  
Life Support ◽  
Ischemia Reperfusion ◽  
Balloon Occlusion ◽  
Low Flow ◽  
Massive Gastrointestinal Bleeding ◽  
Occlusive Mesenteric Ischemia ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a method of controlling intra-abdominal bleeding in case of hemorrhagic shock and an adjunct to improve traditional advanced cardiac life support in nontraumatic cardiac arrest. Partial REBOA is proposed as an alternative method that regulates low volume continuous blood flow across the area of occlusion with the aim of minimizing ischemia-reperfusion injury. Case Presentation: An 82-year-old male suffered an out-of-hospital cardiac arrest due to massive gastric bleeding. He was initially resuscitated with partial REBOA but died of non-occlusive mesenteric ischemia (NOMI). The possible causes of NOMI were the patient’s age, the low flow state with prolonged cardiopulmonary resuscitation, the lower proximal-to-distal gradient of partial REBOA, and the longer time of total occlusion. Conclusion: Further studies may be required to determine the optimal distal pressure during partial REBOA to limit the burden of mesenteric ischemia.

scholarly journals REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

2021 ◽  
Author(s):  
Jostein Rødseth Brede ◽  
Arne Kristian Skulberg ◽  
Marius Rehn ◽  
Kjetil Thorsen ◽  
Pål Klepstad ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Multicentre Trial ◽  
Life Support ◽  
Intervention Group ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Adjunctive Treatment ◽  
Control Group ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Abstract Background Survival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports. Methods This multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 minutes. The secondary objectives of this trial are to measure 30-day survival with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events. Discussion Results from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort. Trial registration The trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.

Abstract 150: Impact of Epinephrine on ECG Changes During Resuscitation From Out-of-Hospital Cardiac Arrest With Initial Pulseless Electrical Activity

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Gunnar W Skjeflo ◽  
Eirik Skogvoll ◽  
Jan Pål Loennechen ◽  
Theresa M Olasveengen ◽  
Lars Wik ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Multivariate Regression ◽  
Life Support ◽  
Controlled Trial ◽  
Pulseless Electrical Activity ◽  
Qrs Complex ◽  
Epinephrine Administration ◽  
Hospital Cardiac Arrest

Introduction: Presence of electrocardiographic rhythm, documented by the electrocardiogram (ECG), in the absence of palpable pulses defines pulseless electrical activity (PEA). Our aims were to examine the development of ECG characteristics during advanced life support (ALS) from Out-of-Hospital-Cardiac-Arrest (OHCA) with initial PEA, and to explore the effects of epinephrine on these characteristics. Methods: Patients with OHCA and initial PEA in a randomized controlled trial of ALS with or without intravenous access and medications were included. QRS widths and heart-rates were measured in recorded ECG signals during pauses in compressions. Statistical analysis was carried out by multivariate regression (MANOVA). Results: Defibrillator recordings from 170 episodes of cardiac arrest were analyzed, 4840 combined measurements of QRS complex width and heart rate were made. By the multivariate regression model both whether epinephrine was administered and whether return of spontaneous circulation (ROSC) was obtained were significantly associated with changes in QRS width and heart rate. For both control and epinephrine groups, ROSC was preceded by decreasing QRS width and increasing rate, but in the epinephrine group an increase in rate without a decrease in QRS width was associated with poor outcome (fig). Conclusion: The QRS complex characteristics are affected by epinephrine administration during ALS, but still yields valuable prognostic information.

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