Brant-Zawadzki Graham, Hoareau Guillaume L, Stoecklein H Hill, Levin Nicholas, Selzman Craig H, Ciullo Anna, Tonna Joseph, Kelly Christopher, Jones Jamal, Youngquist Scott T, Johnson M Austin
Department of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
Nora-Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
Resusc Plus. 2024 Sep 21;20:100784. doi: 10.1016/j.resplu.2024.100784. eCollection 2024 Dec.
Cardiac arrest afflicts over 600,000 people annually in the United States. Rates of survival from cardiac arrest have remained stagnant for decades. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is most commonly used in the management of severe hemorrhagic shock, primarily for non-compressible thoracoabdominal trauma. A growing body of evidence suggests it may serve a role in augmenting cardiac and cerebral perfusion in non-traumatic, refractory cardiac arrest. Typically, REBOA is deployed by interventional radiologists under real-time fluoroscopy. Limited data exist to demonstrate the feasibility or logistics of successful REBOA deployment in emergency departments by emergency medicine physicians.
We describe an emergency medicine-driven training program and treatment protocol developed to deploy REBOA in the emergency department for patients experiencing refractory out-of-hospital cardiac arrest and deemed ineligible for ECPR. We detail the training, certification processes, and clinical outcomes from our first eight cases.
Five emergency medicine physicians underwent training for REBOA placement through a didactic curriculum and hands-on training with mannequin and live tissue porcine models. Since protocol implementation, eight patients have undergone REBOA catheterization by emergency medicine physicians: 5 males and 3 females, age range 25-79. The first pass success was 8/8 (100 %), and all 3 commercially available catheters in the United States were successfully used. ROSC was achieved in 3/8 (37.5 %) patients, although no patients survived to hospital discharge. No REBOA catheter-associated complications were identified.
This series demonstrates feasibility of emergency physician placed REBOA for non-traumatic, refractory cardiac arrest a novel resuscitative technique. Through a combination of focused education, innovative technology use, robust large animal model-based training, and strategic procedural integration, we showcase the potential for emergency departments to spearhead the adoption of this potentially life-saving intervention.
在美国，心脏骤停每年折磨着超过60万人。心脏骤停的生存率几十年来一直停滞不前。主动脉内复苏球囊阻断术（REBOA）最常用于严重失血性休克的治疗，主要用于不可压迫的胸腹创伤。越来越多的证据表明，它可能在非创伤性、难治性心脏骤停中增强心脏和大脑灌注方面发挥作用。通常，REBOA由介入放射科医生在实时荧光透视下进行部署。仅有有限的数据来证明急诊科医生在急诊科成功部署REBOA的可行性或操作流程。
我们描述了一个由急诊医学推动的培训项目和治疗方案，该方案旨在为院外难治性心脏骤停且被认为不适合进行体外心肺复苏（ECPR）的患者在急诊科部署REBOA。我们详细介绍了前八例患者的培训、认证过程和临床结果。
五名急诊医学医生通过理论课程以及使用人体模型和活体组织猪模型的实践培训接受了REBOA放置培训。自方案实施以来，八名患者接受了急诊医学医生进行的REBOA导管插入术：5名男性和3名女性，年龄范围为25 - 79岁。首次通过成功率为8/8（100%），并且成功使用了美国所有三种市售导管。3/8（37.5%）的患者实现了自主循环恢复（ROSC），尽管没有患者存活至出院。未发现与REBOA导管相关的并发症。
本系列研究证明了急诊医生为非创伤性、难治性心脏骤停放置REBOA这一新型复苏技术的可行性。通过集中教育、创新技术应用、基于大型动物模型的强化培训以及策略性的程序整合相结合，我们展示了急诊科率先采用这种潜在救命干预措施的潜力。
