Aziz Shadman, Barratt Jon, Wilson-Baig Noamaan, Lachowycz Kate, Major Rob, Barnard Ed B G, Rees Paul
Department of Research, Audit, Innovation, and Development (RAID). East Anglian Air Ambulance, Norwich, UK.
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, UK.
Resusc Plus. 2024 Jun 13;19:100688. doi: 10.1016/j.resplu.2024.100688. eCollection 2024 Sep.
Fewer than one in ten out-of-hospital cardiac arrest (OHCA) patients survive to hospital discharge in the UK. For prehospital teams to improve outcomes in patients who remain in refractory OHCA despite advanced life support (ALS); novel strategies that increase the likelihood of return of spontaneous circulation, whilst preserving cerebral circulation, should be investigated. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has been shown to improve coronary and cerebral perfusion during cardiopulmonary resuscitation. Early, prehospital initiation of REBOA may improve outcomes in patients who do not respond to standard ALS. However, there are significant clinical, technical, and logistical challenges with rapidly delivering prehospital REBOA in OHCA; and the feasibility of delivering this intervention in the UK urban-rural setting has not been evaluated.
The Emergency Resuscitative Endovascular Balloon Occlusion of the Aorta in Out-of-Hospital Cardiac Arrest (ERICA-ARREST) study is a prospective, single-arm, interventional feasibility study. The trial will enrol 20 adult patients with non-traumatic OHCA. The primary objective is to assess the feasibility of performing Zone I (supra-coeliac) aortic occlusion in patients who remain in OHCA despite standard ALS in the UK prehospital setting. The trial's secondary objectives are to describe the hemodynamic and physiological responses to aortic occlusion; to report key time intervals; and to document adverse events when performing REBOA in this context.
Using compressed geography, and targeted dispatch, alongside a well-established femoral arterial access programme, the ERICA-ARREST study will assess the feasibility of deploying REBOA in OHCA in a mixed UK urban and rural setting.Trial registration.ClinicalTrials.gov (NCT06071910), registration date October 10, 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06071910.
在英国，每十名院外心脏骤停（OHCA）患者中，存活至出院的不到一人。对于尽管接受了高级生命支持（ALS）但仍处于难治性OHCA的患者，院前急救团队若要改善其预后，应研究能增加自主循环恢复可能性同时保留脑循环的新策略。主动脉内球囊阻断复苏术（REBOA）已被证明可改善心肺复苏期间的冠状动脉和脑灌注。早期在院前启动REBOA可能会改善对标准ALS无反应患者的预后。然而，在OHCA中快速实施院前REBOA存在重大的临床、技术和后勤挑战；且尚未评估在英国城乡环境中实施这种干预措施的可行性。
院外心脏骤停时紧急主动脉内球囊阻断复苏术（ERICA - ARREST）研究是一项前瞻性、单臂、介入性可行性研究。该试验将招募20名非创伤性OHCA成年患者。主要目的是评估在英国院前环境中，尽管接受了标准ALS但仍处于OHCA的患者中进行I区（膈上）主动脉阻断的可行性。该试验的次要目的是描述对主动脉阻断的血流动力学和生理反应；报告关键时间间隔；并记录在此背景下进行REBOA时的不良事件。
通过压缩地理区域和有针对性的调度，以及完善的股动脉穿刺接入计划，ERICA - ARREST研究将评估在英国城乡混合环境中对OHCA患者部署REBOA的可行性。试验注册。ClinicalTrials.gov（NCT06071910），注册日期2023年10月10日，https://classic.clinicaltrials.gov/ct2/show/NCT06071910 。
