PMID- 32750628
OWN - NLM
STAT- MEDLINE
DCOM- 20201102
LR  - 20201117
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Print)
IS  - 0735-6757 (Linking)
VI  - 38
IP  - 9
DP  - 2020 Sep
TI  - Zone 3 REBOA does not provide hemodynamic benefits during nontraumatic cardiac 
      arrest.
PG  - 1915-1920
LID - S0735-6757(20)30479-4 [pii]
LID - 10.1016/j.ajem.2020.06.003 [doi]
AB  - BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) may 
      be a novel intervention to improve cardiopulmonary resuscitation (CPR) quality 
      during cardiac arrest. Zone 1 supraceliac aortic occlusion improves coronary and 
      cerebral blood flow. It is unknown if Zone 3 occlusion distal to the renal 
      arteries offers a similar physiologic benefit while maintaining blood flow to 
      organs above the point of occlusion. METHODS: Fifteen swine were anesthetized, 
      instrumented, and placed into ventricular fibrillation. Mechanical CPR was 
      immediately initiated. After 5 min of CPR, Zone 1 REBOA, Zone 3 REBOA, or no 
      intervention (control) was initiated. Hemodynamic variables were continuously 
      recorded for 30 min. RESULTS: There were no significant differences between 
      groups before REBOA deployment. Once REBOA was deployed, Zone 1 animals had 
      statistically greater diastolic blood pressure compared to control (median [IQR]: 
      19.9 mmHg [9.5-20.5] vs 3.9 mmHg [2.4-4.8], p = .006). There were no differences 
      in diastolic blood pressure between Zone 1 and Zone 3 (8.6 mmHg [5.1-13.1], 
      p = .10) or between Zone 3 and control (p = .10). There were no significant 
      differences in systolic blood pressure, cerebral blood flow, or time to return of 
      spontaneous circulation (ROSC) between groups. CONCLUSION: In our swine model of 
      cardiac arrest, Zone 1 REBOA improved diastolic blood pressure when compared to 
      control. Zone 3 does not offer a hemodynamic benefit when compared to no 
      occlusion. Unlike prior studies, immediate use of REBOA after arrest did not 
      result in an increase in ROSC rate, suggesting REBOA may be more beneficial in 
      patients with prolonged no-flow time. INSTITUTIONAL PROTOCOL NUMBER: 
      FDG20180024A.
CI  - Published by Elsevier Inc.
FAU - Nowadly, Craig D
AU  - Nowadly CD
AD  - Clinical Investigation Facility, David Grant United States Air Force Medical 
      Center, Travis Air Force Base, California, United States of America; Department 
      of Emergency Medicine, University of California at Davis, Sacramento, CA, United 
      States of America. Electronic address: craig.d.nowadly.mil@mail.mil.
FAU - Hoareau, Guillaume L
AU  - Hoareau GL
AD  - Clinical Investigation Facility, David Grant United States Air Force Medical 
      Center, Travis Air Force Base, California, United States of America; Division of 
      Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, 
      United States of America.
FAU - Grayson, J Kevin
AU  - Grayson JK
AD  - Clinical Investigation Facility, David Grant United States Air Force Medical 
      Center, Travis Air Force Base, California, United States of America.
FAU - Johnson, M Austin
AU  - Johnson MA
AD  - Clinical Investigation Facility, David Grant United States Air Force Medical 
      Center, Travis Air Force Base, California, United States of America; Division of 
      Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, 
      United States of America.
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20200618
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
SB  - IM
MH  - Animals
MH  - *Aorta/physiopathology
MH  - Balloon Occlusion/*methods
MH  - Cardiopulmonary Resuscitation/*methods
MH  - Disease Models, Animal
MH  - Female
MH  - Heart Arrest/physiopathology/*therapy
MH  - *Hemodynamics
MH  - Male
MH  - Swine
PMC - PMC7301802
OTO - NOTNLM
OT  - Aortic occlusion
OT  - Cardiopulmonary resuscitation
OT  - Endovascular
OT  - Intra-aortic balloon
OT  - Resuscitation
COIS- Declaration of competing interest C.D.N. reports no conflict of interest. GLH 
      reports no conflict of interest. JKG reports no conflict of interest. M.A.J. is a 
      founder and stockholder of Certus Critical Care, Inc. that produces a product 
      relevant to the subject material.
EDAT- 2020/08/05 06:00
MHDA- 2020/11/03 06:00
PMCR- 2020/06/18
CRDT- 2020/08/05 06:00
PHST- 2020/03/31 00:00 [received]
PHST- 2020/05/29 00:00 [revised]
PHST- 2020/06/02 00:00 [accepted]
PHST- 2020/08/05 06:00 [pubmed]
PHST- 2020/11/03 06:00 [medline]
PHST- 2020/08/05 06:00 [entrez]
PHST- 2020/06/18 00:00 [pmc-release]
AID - S0735-6757(20)30479-4 [pii]
AID - 10.1016/j.ajem.2020.06.003 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2020 Sep;38(9):1915-1920. doi: 10.1016/j.ajem.2020.06.003. Epub 
      2020 Jun 18.