Abstract 357: Resuscitative Balloon Occlusion of the Aorta in Non-Traumatic out of Hospital Cardiac Arrest - Evaluation of an Educational Program

Abstract

Background: Out of hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation and hence oxygen delivery to vital organs such as the brain and heart during cardio-pulmonal resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data supports that patients in non-traumatic CA might benefit from REBOA placed in the thoracic level during CPR. Methods: We developed a REBOA team-based training program involving the physicians and prehospital emergency medical service (P-EMS) operators working on the National Air Ambulance helicopter base in Trondheim, Norway. The program consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application (OSAPRA) scoring chart and a special designed training dummy was made for this study. Results: 7 physicians and 3 P-EMS operators participated. The time needed to perform the REBOA procedure was 8,5 min (range; 6,3 - 12,7). The corresponding time from arrival at scene to balloon inflation was 12,0 min (range; 8,8 - 15). The total objective assessment scores of the candidates’ competency was 41,8 points out of 48 (range; 39 - 43,5). The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure. Conclusions: This four-step approach to educate, train and implement the REBOA technique to a prehospital working team is feasible and provides adequate competence. In a simulated setting the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS.