170 Use of Transthoracic Ultrasound to Confirm Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta in Medical Cardiac Arrest

Abstract

The objective of this study is to assess the feasibility of using bedside ultrasound to visualize and confirm aortic placement of resuscitative endovascular balloon occlusion of the aorta (REBOA) within an emergency medicine (EM)-initiated multi-disciplinary protocol in non-traumatic OHCA. REBOA is a hemorrhage control technique involving the intra-vascular occlusion of the thoracic aorta using a balloon catheter and may help to increase coronary and cerebral perfusion during non-traumatic out-of-hospital cardiac arrest (OHCA) by directing blood flow to the upper body. We are conducting a single-arm early feasibility study of REBOA initiated in the emergency department (ED) for OHCA using an investigational device approval by the Food and Drug Administration (FDA) with an exception from informed consent. During CPR, an emergency physician obtains common femoral access using a 7Fr introducer sheath while the REBOA catheter is prepared and subsequently advanced by an interventional radiologist (IR). While sheath introducer placement can be confirmed with ultrasound views of the common femoral artery, we seek to confirm intrathoracic REBOA placement using transthoracic bedside ultrasound. Our goal is to enroll 20 patients into this study and use transthoracic ultrasound to confirm REBOA placement in each. Two of the initial twenty patients were enrolled between January and February 2020, with a temporary pause in enrollment due to the COVID pandemic from March to July 2020. In both enrolled patients, transthoracic views were obtained confirming intra-thoracic aortic placement of REBOA by an emergency physician. In our initial two cases, thoracic aortic placement of the REBOA in non-traumatic OHCA was confirmed by emergency physicians using transthoracic ultrasound. This demonstrates correct placement of aortic endovascular devices can be confirmed using emergency physician operated ultrasound. Further research is needed to determine what factors may impact emergency physicians’ ability to successfully identify and confirm aortic device placement.