Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
Resuscitation. 2021 Aug;165:161-169. doi: 10.1016/j.resuscitation.2021.05.019. Epub 2021 Jun 3.
Out of hospital cardiac arrest (OHCA) is still a leading cause of mortality worldwide. In recent years, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been progressively studied as an adjunct to standard advanced life support (ALS) in both traumatic and non-traumatic refractory OHCA. Since January 2019, the REBOA procedure has been applied to all the patients experiencing both traumatic and non-traumatic refractory OHCA (≥15 min of cardiopulmonary resuscitation) not eligible for ECPR for clinical or logistic reasons. We aimed at describing the feasibility and effects of REBOA performed both in the Emergency Department and in the pre-hospital environment served by the local HEMS for refractory OHCA.
Twenty consecutive patients experiencing refractory OHCA and in whom REBOA was attempted in 2019 and 2020 were included in the study, Utstein data and REBOA specific variables were recorded.
Successful catheter placement was achieved in 18 out of 20 patients, 11 of these were non-traumatic OHCAs while 7 were traumatic OHCAs, the 2 failures were related to repeated arterial puncture failure. Median time between the EMS dispatch and REBOA catheter placing attempt was 46 min. An increase in etCO over 10 mmHg was observed after balloon inflation in 12 out of 18 patients (8/11 non-traumatic and 4/7 traumatic OHCAs), a sustained ROSC was observed in 5 patients (1 traumatic and 4 non-traumatic OHCA) that were subsequently admitted to the ICU. Four out of the 5 patients reached the criteria for brain death in the subsequent 24 h while one patient experienced another episode of refractory cardiac arrest in ICU and subsequently died.
Our data confirm the feasibility of REBOA technique as an adjunct to ALS in both the ED and prehospital phase and most of the treated patients experienced a transient ROSC after balloon inflation while 5 out of 18 experienced a sustained ROSC. However, while in the trauma setting increasing evidence suggests an improved survival when REBOA is applied to refractory OHCA, in non-traumatic OHCA this has yet to be demonstrated and large studies are needed.
院外心脏骤停（OHCA）仍然是全球主要的死亡原因。近年来，在创伤性和非创伤性难治性 OHCA 中，主动脉球囊阻断复苏（REBOA）作为标准高级生命支持（ALS）的辅助手段已逐渐得到研究。自 2019 年 1 月以来，REBOA 程序已应用于所有因临床或后勤原因不符合体外心肺复苏（ECPR）条件而经历创伤性和非创伤性难治性 OHCA（心肺复苏>15 分钟）的患者。我们旨在描述在急诊科和当地 HEMS 服务的院前环境中对难治性 OHCA 进行 REBOA 的可行性和效果。
2019 年和 2020 年，共纳入 20 例难治性 OHCA 患者，其中 18 例尝试进行 REBOA，记录了 Utstein 数据和 REBOA 特定变量。
20 例患者中，18 例成功放置导管，其中 11 例为非创伤性 OHCA，7 例为创伤性 OHCA，2 例失败与反复动脉穿刺失败有关。EMS 调度和 REBOA 导管放置尝试之间的中位时间为 46 分钟。在 18 例患者中，有 12 例（11 例非创伤性和 4 例创伤性 OHCA）在球囊充气后观察到 ETCO 升高>10mmHg，5 例（1 例创伤性和 4 例非创伤性 OHCA）出现持续 ROSC，随后转入 ICU。在随后的 24 小时内，5 名患者中的 4 名达到脑死亡标准，而 1 名患者在 ICU 中再次发生难治性心脏骤停并随后死亡。
我们的数据证实，REBOA 技术作为 ALS 的辅助手段，在急诊科和院前阶段均具有可行性，大多数接受治疗的患者在球囊充气后经历短暂的 ROSC，而 18 例中有 5 例经历持续的 ROSC。然而，在创伤性情况下，越来越多的证据表明，在难治性 OHCA 中应用 REBOA 可提高生存率，而非创伤性 OHCA 尚未得到证实，需要进行大规模研究。
