-
Is there a place for REBOA in cardiac arrest?
by Christopher Foerster. Last modified: 09/01/16
Foerster CR1, Turgulov A2. Prehospital endovascular occlusion of the aorta is now a technically feasible strategy for improving haemodynamics in CPR. Resuscitation. 2015 Aug;93:e25. PMID: 26049132.The CHEER trial that showed that patients with refractory VF cardiac arrest who previously would have been pronounced dead in the field can survive with a good neurological outcome if they receive effective circulatory support and definitive intervention in hospital. This suggests that we need to rethink our approach to resuscitation to consider whether we can make CPR more effective to improve the chance getting our patients to definitive care while still potentially viable when defibrillation has been unsuccessful. This is the thought that led to the proposal recently published in Resuscitation that the resuscitative endovascular balloon occlusion of the aorta (REBOA) technique could be useful in prehospital medical cardiac arrest. By occluding circulation to non-vital areas of the body and improving perfusion to the heart and brain, it may someday play a role in the treatment of refractory cardiac arrest.
There are barriers to seeing this idea implemented, even if the intended physiological impact is seen. These are primarily technical challenges having to do with the need to achieve femoral artery access for endovascular occlusion of the aorta, which to our knowledge has not yet been done during cardiac arrest. Widespread use of the technique would also be limited by the need to have practitioners in the field who are competent in the technique and perform it frequently enough to maintain the skill.
Despite these challenges, this novel resuscitation strategy is worth exploring further to determine feasibility, later to be followed by an assessment of efficacy if it is found to be technically feasible. Please read the full letter and share your thoughts in the comments below.
Link to letter: http://www.resuscitationjournal.com/article/S0300-9572(15)00230-0/fulltext
References
1.Foerster CR1, Turgulov A2. Prehospital endovascular occlusion of the aorta is now a technically feasible strategy for improving haemodynamics in CPR. Resuscitation. 2015 Aug;93:e25. PMID: 26049132.
The following two tabs change content below.Christopher Foerster
Chris is a paramedic with Lambton EMS in Ontario, Canada and is active in paramedic education and research.Latest posts by Christopher Foerster (see all)
- Paramedic students…write something! - 28/04/16
- Is there a place for REBOA in cardiac arrest? - 09/01/16
2 thoughts on “Is there a place for REBOA in cardiac arrest?”
Leave a Reply
Is there a place for REBOA in cardiac arrest?
Get weekly email updates!
Cast Your Vote

Categories
- Blogs (40)
- Case Studies (8)
- Featured Article (23)
- How-To (47)
- FOAM (8)
- News (117)
- Conference Tweets (31)
- Pharmacology (1)
- Adrenaline (1)
- Research (180)
- Advanced Practice (2)
- Airway Management (6)
- Anaphylaxis (2)
- Cardiac (15)
- Community Paramedic (2)
- Critical Care Paramedic (4)
- Diagnostics (3)
- Dispatch (1)
- ECG (4)
- Education (10)
- EMS Operations (2)
- End-of-Life Care (3)
- Geriatrics (9)
- Guidelines (22)
- HEMS (4)
- Mass Casualty (2)
- Medical Conditions (5)
- Mental Health (7)
- Military & Tactical (2)
- Neonatal (1)
- Neuro (11)
- Obstetrics (1)
- Paediatrics (4)
- Pain Management (4)
- Poster Presentations (5)
- Professionalism (5)
- Remote, Industrial & Austere (6)
- Respiratory (5)
- Resuscitation (27)
- Rural (3)
- Safety (3)
- Sepsis (7)
- Shock (2)
- Simulation (7)
- Sports Medicine (1)
- Trauma (20)
- Reviews (6)
- Conferences (5)
- Courses (1)
Upcoming Events
There are no upcoming events at this time.
News
- Free access: Resuscitation Today Vol 3 Issue 2 (27/06/16)
- Free CPD at the Emergency Services Show (23/05/16)
- Canadian Paramedicine Feb/Mar 2016 – Open Access Issue (11/04/16)
- Free access: Resuscitation Today Volume 3 Issue 1 (01/04/16)
- Introducing the Irish Journal of Paramedicine (22/11/15)
Latest How-To Articles
- Paramedic students…write something! (28/04/16)
- Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice (30/01/15)
- Understanding diagnostic tests 1: sensitivity, specificity and predictive values (11/12/14)
- GRADE guidelines – best practices using the GRADE framework (22/11/14)
- How to get started with EMS research – JEMS (16/05/14)
Recent Comments
- Jin Sook Hyun on Case Study #2: Anaphylaxis
- Joe on Case Study #1: Heroin overdose
- Stef on C.R.A.S.H.E.D – A model for structured reflection in prehospital care.
- G. Yabut, RN on Rapid Reviews: Vital signs in CVAs – which arm?
ReSEARCH
Tags
academic ACS airway management ambulance AMI Australia Canada cardiac cardiac arrest case study clinical management computer conference consensus CPG CPR CPR UL critical care CVA database ECG education elderly emergency EMS evidence based FOAM FPHC geriatric guide guideline guidelines haemorrhage HEMS Ireland journal medication mental health neurology news OHCA online paediatric pain management paramedic prehospital PTSD reference research resuscitation review safety sepsis septic shock simulation social media software spinal STEMI stress stroke Student Paramedic study TBI training Translational Health Sciences trauma Twitter UK USA
Archives
Christopher
A great topic close to my heart!
I think certainly the animal data is very compelling, and as you say shows great improvement in cardio-cerebral perfusion in those models. I think as catheter technology evolves, and as we recently discussed in our paper (http://www.resuscitationjournal.com/article/S0300-9572(15)00398-6/abstract), REBOA will have a place in non-traumatic arrest potentially as a bridge to ECMO or other techniques. I think what will be particularly fascinating is the evolution of work by people like Dr Jim Manning on selective aortic arch perfusion (SAAP) and incorporating that into cardiac arrest algorithms. The future is very exciting!
You mention in your piece the technical aspects of femoral access. I think this is a critical point, and certainly with the currently used equipment in North America, this emphasizes the great importance of appropriate training. The technology here is evolving and will soon allow the use of smaller sheaths and catheters, but this is still a little ways away. Internationally however they are already using smaller sheaths, and we can certainly all learn from their experience.
Additionally, although REBOA placement in arrest in the prehospital setting has not yet been reported (or to my knowledge been done), we have done it in hospital in traumatic cardiac arrest. In the arrest state, the artery is primarily accessed via a groin cutdown technique, although ultrasound can also be utilized.
Thanks for your contribution to this topic.
Zaf
Thank you very much for your comments and for sharing a link to your review, Dr. Qasim. The future certainly is exciting! Did you experience any unexpected challenges in using the REBOA in your patient in traumatic cardiac arrest?
Anuar and I have also not yet heard of a case of REBOA placement in a patient in cardiac arrest in the prehospital setting but we are interested in the possibility of this taking place. It seemed like our European colleagues might be the best situated for this with their more widespread use of critical care physicians in the field than we generally have in North America. Do you anticipate that there might be an American EMS system where there is direct field involvement of physicians who would be able to apply this technique for a patient in medical cardiac arrest?
Thank you again for taking the time to share your insights!
Chris