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Use of resuscitative balloon occlusion of the aorta in a swine model of prolonged cardiac arrest.

Tiba MH, McCracken BM, Cummings BC, Colmenero CI, Rygalski CJ, Hsu CH, Sanderson TH, Nallamothu BK, Neumar RW, Ward KR. Use of resuscitative balloon occlusion of the aorta in a swine model of prolonged cardiac arrest. Resuscitation. 2019 Jul 1; 140:106-112.

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Abstract:

AIM: We examined the use of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter during cardiopulmonary resuscitation (CPR) after cardiac arrest (CA) to assess its effect on haemodynamics such as coronary perfusion pressure (CPP), common carotid artery blood flow (CCA-flow) and end-tidal CO (PetCO) which are associated with increased return of spontaneous circulation (ROSC). METHODS: Six male swine were instrumented to measure CPP, CCA-Flow, and PetCO. A 7Fr REBOA was advanced into zone-1 of the aorta through the femoral artery. Ventricular fibrillation was induced and untreated for 8?min. CPR (manual then mechanical) was initiated for 24?min. Continuous infusion of adrenaline (epinephrine) was started at minute-4 of CPR. The REBOA balloon was inflated at minute-16 for 3?min and then deflated/inflated every 3?min for 3 cycles. Animals were defibrillated up to 6 times after the final cycle. Animals achieving ROSC were monitored for 25?min. RESULTS: Data showed significant differences between balloon deflation and inflation periods for CPP, CCA-Flow, and PetCO (p? < 0.0001) with an average difference (SD) of 13.7 (2.28)?mmHg, 15.5 (14.12)?mL?min and -4 (2.76)?mmHg respectively. Three animals achieved ROSC and had significantly higher mean CPP (54 vs. 18?mmHg), CCA-Flow (262 vs. 135?mL?min) and PetCO (16 vs. 8?mmHg) (p? < 0.0001) throughout inflation periods than No-ROSC animals. Aortic histology did not reveal any significant changes produced by balloon inflation. CONCLUSION: REBOA significantly increased CPP and CCA-Flow in this model of prolonged CA. These increases may contribute to the ability to achieve ROSC.




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