Abstract Body: Introduction/Background
Resuscitative endovascular balloon occlusion of the aorta (REBOA), initially developed to manage non-compressible torso hemorrhage, is a promising intervention for enhancing coronary and cerebral perfusion in non-traumatic cardiac arrest. This procedure can increase rate of return of spontaneous circulation (ROSC) or serve as a bridge to extracorporeal cardiopulmonary resuscitation (ECPR).

Research Questions/Hypothesis
We hypothesized that emergency physicians, following an educational program including didactics, simulation, and live tissue trainings, would demonstrate successful and safe REBOA placement in adults with out-of-hospital cardiac arrest (OHCA).

Goals/Aims
This study aims to evaluate the first-pass success rate of REBOA placed by trained emergency physicians during treatment of OHCA in the emergency department.

Methods/Approach
This was a retrospective review of emergency physician-placed REBOA devices. Five board-certified Emergency Medicine attending physicians were trained using didactics, hands-on simulations, and live tissue training in pigs, followed by an objective competency assessment using the REBOA Rating of Skills tool (REBOA-RATE). REBOA device selection was based on availability within the emergency department.

Patient Selection: Patients were selected based on provider discretion, specifically those who did not meet institutional ECPR criteria. Inclusion criteria included patients aged 18-80 with a witnessed arrest who had received at least 15 minutes of standard advanced cardiac life support interventions. Exclusion criteria included known end-stage organ disease, trauma, or dementia.

Results/Data:
Eight patients, 5 males and 3 females (age range 25-79), underwent REBOA placement. First pass success was 8/8 (100%) REBOA catheters from all 3 commercially available catheters in the United States were used. ROSC was achieved in 3/8 (37.5%) patients, although all patients died after hospital admission. No REBOA associated complications were identified on imaging or autopsy reports.

Conclusions:
All REBOA placements performed by trained emergency physicians in patients with OHCA were successful after our training protocol, resulting in ROSC in 37.5% with no long term survivors. Based on the demonstrated success rate, we hope to further examine the feasibility and utility of REBOA in the pre-hospital setting for patients with refractory cardiac arrest as a bridge to earlier ROSC or additional ECPR therapies.