Randomized blinded trial of automated REBOA during CPR in a porcine model of cardiac arrest

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) reportedly elevates arterial blood pressure (ABP) during non-traumatic cardiac arrest. Objectives This randomized, blinded trial of cardiac arrest in pigs evaluated the effect of automated REBOA two minutes after balloon inflation on ABP (primary endpoint) as well as arterial blood gas values and markers of cerebral haemodynamics and metabolism. Methods Twenty anesthetized pigs were randomized to REBOA inflation or sham-inflation (n = 10 in each group) followed by insertion of invasive monitoring and a novel, automated REBOA catheter (NEURESCUE® Catheter & NEURESCUE® Assistant). Cardiac arrest was induced by ventricular pacing. Cardiopulmonary resuscitation was initiated three min after cardiac arrest, and the automated REBOA was inflated or sham-inflated (blinded to the investigators) five min after cardiac arrest. Results In the inflation compared to the sham group, mean ABP above the REBOA balloon after inflation was higher (inflation: 54 (95%CI: 43–65) mmHg; sham: 44 (33–55) mmHg; P = 0.06), and diastolic ABP was higher (inflation: 38 (29–47) mmHg; sham: 26 (20–33) mmHg; P = 0.02), and the arterial to jugular oxygen content difference was lower (P = 0.04). After return of spontaneous circulation, mean ABP (inflation: 111 (95%CI: 94–128) mmHg; sham: 94 (95%CI: 65–123) mmHg; P = 0.04), diastolic ABP (inflation: 95 (95%CI: 78−113) mmHg; sham: 78 (95%CI: 50−105) mmHg; P = 0.02), CPP (P = 0.01), and brain tissue oxygen tension (inflation: 315 (95%CI: 139−491)% of baseline; sham: 204 (95%CI: 75−333)%; P = 0.04) were higher in the inflation compared to the sham group. Conclusion Inflation of REBOA in a porcine model of non-traumatic cardiac arrest improves central diastolic arterial pressure as a surrogate marker of coronary artery pressure, and cerebral perfusion. Institutional protocol number 2017-15-0201-01371.