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Traumatic cardiac arrest and resuscitative endovascular balloon occlusion of the aorta (REBOA): a preliminary analysis utilizing high fidelity invasive blood pressure recording and videography

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Abstract

Purpose

Aortic occlusion (AO) increases proximal perfusion and may improve rates of return of spontaneous circulation (ROSC). The objective of this study was to investigate the hemodynamic effects of cardiopulmonary resuscitation (CPR) and AO by REBOA on patients in traumatic cardiac arrest.

Methods

Patients admitted between February 2013 and May 2017 at a tertiary center who suffered traumatic arrest, had an arterial line placed during resuscitation, and received CPR and REBOA which were included. In-hospital CPR data were obtained from videography. Arterial waveforms were recorded at 240 Hz.

Results

11 consecutive patients were included, 82% male; mean (± SD) age 37 ± 19 years. 55% suffered blunt trauma and the remaining penetrating injuries. 64% arrested out of hospital. During compressions with AO, the mean systolic blood pressure (SBP) was 70 ± 22 mmHg, mean arterial pressure (MAP) 43 ± 19 mmHg, and diastolic blood pressure (DBP) 26 ± 17 mmHg. Nine (82%) had ROSC, with eight having multiple periods of ROSC and arrest in the initial period. In-hospital mortality was 82%. Cardiac ultrasonography was used during arrest in 73%. In two patients with arterial line data before and after AO, SBP (mmHg) improved from 51 to 73 and 55 to 96 during arrest after AO.

Conclusions

High-quality chest compressions coupled with aortic occlusion may generate adequate perfusion pressures to increase the rate of ROSC. New technology capable of transducing central arterial pressure may help us to understand the effectiveness of CPR with and without aortic occlusion. REBOA may be a useful adjunct to high-quality chest compressions during arrest.

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Funding

This study was funded in part by a grant from the Department of Defense (Grant number W81XWH-15-1-0025).

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Authors and Affiliations

  1. Program in Trauma/Critical Care RA Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Philip J. Wasicek, Shiming Yang, William A. Teeter, Peter Hu, Deborah M. Stein, Thomas M. Scalea & Megan L. Brenner

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  1. Philip J. Wasicek
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  2. Shiming Yang
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  3. William A. Teeter
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  4. Peter Hu
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  5. Deborah M. Stein
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  6. Thomas M. Scalea
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  7. Megan L. Brenner
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Corresponding author

Correspondence to Philip J. Wasicek.

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Conflict of interest

Dr. Megan Brenner is a clinical advisory board member for Prytime Medical Inc. Drs. Philip Wasicek, Shiming Yang, William Teeter, Peter Hu, Deborah Stein, and Thomas Scalea declare that they have no conflicts of interest.

Research involving animal and human participants

This study involved human subjects and was compliant with the 1964 Helsinki Declaration and its later amendments, and was compliant with the Institutional Review Board of the University of Maryland, Baltimore.

Ethical approval

This study was approved by the Institutional Review Board of the University of Maryland, Baltimore.

Informed consent

This was a retrospective observational study of prospective collected data, for which formal consent was not required.

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Wasicek, P.J., Yang, S., Teeter, W.A. et al. Traumatic cardiac arrest and resuscitative endovascular balloon occlusion of the aorta (REBOA): a preliminary analysis utilizing high fidelity invasive blood pressure recording and videography. Eur J Trauma Emerg Surg 45, 1097–1105 (2019). https://doi.org/10.1007/s00068-018-0989-5

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  • DOI: https://doi.org/10.1007/s00068-018-0989-5

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