Hemodynamic Effects of Resuscitative Endovascular Balloon Occlusion of the Aorta Deflation in Normal Physiological Conditions and After the Return of Spontaneous Circulation Following Cardiac Arrest
Abstract Body: Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) therapy augments circulation to the heart and brain during cardiopulmonary resuscitation (CPR). However, once return of spontaneous circulation (ROSC) is achieved, immediate REBOA deflation can cause significant loss of blood pressure and other hemodynamics1. Little is known about the potential harmful effects of REBOA deflation, under normal physiological conditions and low circulatory states. Research Question Does REBOA catheter deflation cause a significant decrease in mean arterial pressure (MAP) under normal physiological conditions and after ROSC following cardiac arrest? How long does it take to recover in the absence of additional treatment? Methods For the normal physiological conditions study, 6 pigs were anesthetized and instrumented. The REBOA was inflated to occlude the aorta at the level of the diaphragm for 7 minutes, then deflated completely. For the post-ROSC study, 8 pigs underwent head up (HUP) CPR with active compression decompression CPR, an impedance threshold device, and a head/thorax elevation device. A REBOA was placed after ~44 minutes of CPR. One minute after ROSC, the REBOA was deflated completely. In both studies, hemodynamic parameters were monitored continuously. Statistical comparisons were made using a paired samples t-test. Results Hemodynamic findings before, during, and after the REBOA inflation are shown in Table 1. With REBOA inflation, MAP increased from 95.4±14.6 to 118.0±18.1 mmHg (p=0.01), and following deflation, MAP decreased from 119.1±19.0 to 84.3±24.4 mmHg (p=0.01). Parallel changes were observed other hemodynamics as well. Following REBOA deflation MAP and other hemodynamic parameters required 15 min to return to pre-REBOA values. REBOA during HUP CPR increased key hemodynamic parameters, whereas REBOA deflation post ROSC resulted in a profound and dangerous decrease in MAP from 79.4±33.7 to 50.4±23.4, p=0.017 (Table 2). Conclusion REBOA deflation can lead to significant hypotension under normal conditions and life-threatening hypotension after ROSC. Strategies to maintain MAP during REBOA deflation will be needed to reduce these potentially harmful effects.
1. Segond, N., et al. (2024). Abstract Or108: Optimizing Post-resuscitation Care after Resuscitative Endovascular Balloon Occlusion of the Aorta and Automated Head-up Position Cardiopulmonary Resuscitation. Circulation, 150(Suppl_1), https://doi.org/10.1161/circ.150.suppl_1.or108
Salverda, Bayert
( Hennepin Healthcare Research Inst.
, Minneapolis
, Minnesota
, United States
)
Poorzand, Pouria
( Lehigh Valley Health Network
, Allentown
, Pennsylvania
, United States
)
Moore, Johanna
( Hennepin County Medical Center
, Minneapolis
, Minnesota
, United States
)
Metzger, Anja
( UNIVERSITY OF MINNESOTA
, Lake Elmo
, Minnesota
, United States
)
Suresh, Mithun
( M Health Fairview
, Vadnais Heights
, Minnesota
, United States
)
Segond, Nicolas
( CHU Grenoble Alpes
, Grenoble
, France
)
Johnson, Michael
( University of Utah
, Holladay
, Utah
, United States
)
Lurie, Keith
( UNIV OF MINNESOTA HLTH CTR
, Minneapolis
, Minnesota
, United States
)
Author Disclosures:
Bayert Salverda:DO NOT have relevant financial relationships
| Pouria Poorzand:No Answer
| Johanna Moore:DO NOT have relevant financial relationships
| Anja Metzger:No Answer
| Mithun Suresh:DO NOT have relevant financial relationships
| Nicolas Segond:DO NOT have relevant financial relationships
| Guillaume Debaty:No Answer
| Michael Johnson:No Answer
| Keith Lurie:No Answer
