Abstract 187: Synergy Of Elevation Of The Head And Thorax And Resuscitative Endovascular Balloon Occlusion Of The Aorta In A Porcine Model Of Prolonged Cardiac Arrest: A Pilot Study

Abstract

Background: Two new approaches to improve cardiac arrest outcomes, active compression-decompression (ACD) with an impedance threshold device (ITD) CPR with automated Head Up Positioning, (AHUP-CPR), and resuscitative endovascular balloon occlusion (REBOA) have been studied separately but never together. This was a pilot animal study exploring potential hemodynamic synergy of AHUP+ REBOA after prolonged CPR. Methods: Farm pigs (~40 kg) were sedated, intubated, and anesthetized. Central venous, and intracranial pressures were measured. Bilateral femoral arterial access was obtained for arterial pressure measurement and REBOA placement in the proximal thoracic aorta. Hemodynamics were measured with solid state pressure catheters. The arterial pressure catheter was placed in the thoracic aorta and confirmed via fluoroscopy. After 35 minutes of AHUP CPR, animals underwent two-minute epochs of AHUP-CPR, AHUP+REBOA CPR, ACD+ITD CPR flat + REBOA, and ACD+ITD CPR flat. Pressures are reported as mean (mmHg) ± standard deviation. Comparison testing was not performed in this pilot study. Results: In 4 pigs after 35 minutes, the AHUP CPR cerebral perfusion pressure (CerPP) was 21.1 ± 10.4, aortic compression (AOC) and decompression (AOD) pressures were 43.4 ± 9.1 and 14.1 ± 9.4, and intracranial compression (ICP) and decompression (DIP) pressures were 9.2 ± 2.7 and 6.5 ± 3.6, respectively. With AHUP+REBOA, CerPP was 39.0 ± 8.7, AOC and AOD pressures were 69.2 ± 10.7 and 21.0 ± 8.9, and ICP and DIP 9.7 ± 2.6 and 5.8 ± 2.9. The ACD+ITD CPR flat + REBOA CerPP was 21.7 ± 11.8, AOC and AOD pressures were 57.1 ± 9.5, and ICP and DIP were 20.5 ± 4.1 and 15.9 ± 3.2. The ACD+ITD CPR flat CerPP was 11.2 ± 7.5, AOC and AOD pressures were 38.8 ± 6.7 and 15.9 ± 6.6, and ICP and DIB were 17.4 ± 1.1 and 15.0 ± 1.6. A representative study tracing is shown. Conclusions: The combination of AHUP CPR with REBOA is feasible and may work synergistically after prolonged resuscitation in this ongoing animal study.