Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is widely used in acute trauma care worldwide and has recently been proposed as an adjunct to standard treatments during cardiopulmonary resuscitation in patients with non-traumatic cardiac arrest (NTCA). Several case series have been published highlighting promising results, and further trials are starting. REBOA during CPR increases cerebral and coronary perfusion pressure by increasing the afterload of the left ventricle, thus improving the chances of ROSC and decreasing hypoperfusion to the brain. In addition, it may facilitate the termination of malignant arrhythmias by stimulating baroreceptor reflex. Aortic occlusion could mitigate the detrimental neurological effects of adrenaline, not only by increasing cerebral perfusion but also reducing the blood dilution of the drug, allowing the use of lower doses. Finally, the use of a catheter could allow more precise hemodynamic monitoring during CPR and a faster transition to ECPR. In conclusion, REBOA in NTCA is a feasible technique also in the prehospital setting, and its use deserves further studies, especially in terms of survival and good neurological outcome, particularly in resource-limited settings.
Highlights
The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for the treatment of trauma patients with active bleeding is a widely studied and accepted practice worldwide [1]
The use of REBOA for hemostatic purposes has shown promising results in terms of outcome and has recently been included in the latest guidelines for the management of patients with traumatic cardiac arrest as a rescue option in an attempt to achieve the return of spontaneous circulation (ROSC) [2]
Several groups have started to study the use of REBOA in the management of non-traumatic cardiac arrest (NTCA), proposing several case series and in vivo studies in animal models
Summary
The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for the treatment of trauma patients with active bleeding is a widely studied and accepted practice worldwide [1]. The use of REBOA for hemostatic purposes has shown promising results in terms of outcome and has recently been included in the latest guidelines for the management of patients with traumatic cardiac arrest as a rescue option in an attempt to achieve the return of spontaneous circulation (ROSC) [2]. The progressive development and implementation of extracorporeal cardiac life support (ECLS) have given rise to a series of new considerations on additional treatments for NTCA [5]; this technique is quite expensive [6], challenging in terms of logistics, and requires advanced skills not yet available on a large scale It is worth considering the use of REBOA in NTCA, as this method, which is cheaper and carries a shorter learning curve, can play an important role as an adjunct treatment in settings where the implementation of an ECLS program is not currently feasible
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