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.

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 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 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 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.

scholarly journals Feasibility of Pre‐Hospital Resuscitative Endovascular Balloon Occlusion of the Aorta in Non‐Traumatic Out‐of‐Hospital Cardiac Arrest

2019 ◽  
Vol 8 (22) ◽  
Author(s):  
Jostein Rødseth Brede ◽  
Thomas Lafrenz ◽  
Pål Klepstad ◽  
Eivinn Aardal Skjærseth ◽  
Trond Nordseth ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Balloon Occlusion ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alice Hutin ◽  
Yaël Levy ◽  
Fanny Lidouren ◽  
Matthias Kohlhauer ◽  
Pierre Carli ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Life Support ◽  
Statistical Significance ◽  
Spontaneous Circulation ◽  
Balloon Occlusion ◽  
Swine Model ◽  
Epinephrine Administration ◽  
Traumatic Cardiac Arrest ◽  
Endovascular Balloon Occlusion

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.

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.

Abstract 28: Feasibility and Safety of Pre-Hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Non-Traumatic Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jostein R Brede ◽  
Thomas Lafrenz ◽  
Pål Klepstad ◽  
Eivinn A Skjærseth ◽  
Trond Nordseth ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Femoral Artery ◽  
Monitoring Program ◽  
Safety Monitoring ◽  
Balloon Occlusion ◽  
Mean Width ◽  
The Mean ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Introduction: The proportion of patients surviving to hospital discharge after out of hospital cardiac arrest (OHCA) is low and any measure that may improve circulation to vital organs during cardiopulmonary resuscitation (CPR) is beneficial. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) will redistribute cardiac output to the organs proximal to the occlusion. Animal studies supports that aortic occlusion during CPR might benefit patients suffering from OHCA, but human data are scarce. Methods: We performed an observational study at the helicopter emergency medical service in Trondheim (Norway) to assess the feasibility and safety of establishing REBOA in OHCA patients. The femoral artery was identified by ultrasound and a REBOA catheter was placed in the thoracic aorta. All patients received advanced cardiac life support (ACLS) during the procedure. REBOA eligibility, procedural success and time intervals were registered. A safety monitoring program was conducted to ensure that the procedure did not interfere with the quality of ACLS. Results: REBOA was initiated in ten of 98 OHCA patients. The mean age was 63 years (55-71) and 7 were male. The REBOA procedure was successful in all cases (100%), with 80% success rate on first cannulation attempt. Mean REBOA procedural time was 11,7 minutes (8-16, SD 3,2). End-tidal CO2 (EtCO2) increased by a mean of 1.9 kPa at 60 seconds after inflation compared to baseline (p < 0.001). Six of 10 patients (60%) achieved return of spontaneous circulation, 3 (30%) was admitted to hospital. 30-day survival was 10%. The mean width of the femoral artery and vein during CPR was 5,9 mm (3,6 - 7,4, SD 1,2) and 9,4 mm (5,0 - 12,9, SD 2,9), respectively. The safety monitoring group identified no negative influence on the ACLS quality. Conclusions: This is the first study to assess the pre-hospital use of REBOA in patients with non-traumatic cardiac arrest. The REBOA procedure does not interfere with the quality of the ACLS. REBOA is a feasible adjunct treatment in OHCA. The significant increase in EtCO2 after occlusion suggests improved organ circulation during CPR.

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