Abstract
Introduction: Recent evidence has demonstrated that closed chest compressions (CC) directly over the left ventricle (LV) during traumatic cardiopulmonary arrest (TCPA) improve hemodynamics and return of spontaneous circulation (ROSC) when compared to standard chest compressions. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is also able to improve hemodynamics as well as control hemorrhage during TCPA. Hypothesis: We hypothesized that the combination of REBOA and closed chest compressions located over the LV would result in improved hemodynamics and ROSC in a swine model of TCPA. Methods: Transthoracic echo was used to mark the location of the aortic root and the center of the left ventricle on animals (n=52) which were randomized to receive chest compressions in one of the two locations. Half the animals in each group received REBOA placement so there were four arms. One third of each animal’s blood volume was removed and ventricular fibrillation (VF) was induced to simulate traumatic cardiac arrest. After a period of ten minutes of VF, basic life support (BLS) with mechanical CPR was initiated and performed for ten minutes followed by advanced cardiac life support (ACLS) and blood transfusion for an additional ten minutes. Animals with REBOA had the balloon inflated at minute 6 of BLS. Hemodynamic variables were averaged every two minutes. Results: ROSC increased among standard CC animals with REBOA (33%) compared to standard CC animals without REBOA (0.0%) (p=0.04). Among standard CC animals, aortic systolic blood pressure, right atrial systolic blood pressure and end tidal CO2 (ETCO2) increased during all time intervals of BLS (p<0.005) with REBOA. ETCO2 also increased during BLS among LV CC animals with REBOA compared to LV CC animals without REBOA (p≤0.0001), however, ROSC and other hemodynamics were not significantly different. There was no difference in ROSC or hemodynamics between the LV CC and standard CC groups with REBOA. Conclusions: In our swine model of TCPA, ROSC and hemodynamics are improved among animals receiving standard closed chest compressions, however, there is no additional benefit with REBOA if compressions are performed over the LV.
Published Version
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