Physiological changes after deflation of Resuscitative Endovascular Balloon Occlusion of the Aorta following Automated Head-up Position Cardiopulmonary Resuscitation: a post-hoc analysis.

BACKGROUND

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and the automated head-up position (AHUP) have increasingly both been separately reported during cardiopulmonary resuscitation (CPR). The optimal hemodynamic management of REBOA balloon deflation after the return of spontaneous circulation (ROSC) is unknown. We hypothesized that partial deflation of REBOA rather than full deflation after ROSC would result in better hemodynamic parameters.

METHODS

After 10 min of untreated ventricular fibrillation, AHUP-CPR was performed on 20 pigs (weighting ∼40 kg). After 36 min, a REBOA balloon was inflated. After ROSC (13 pigs) REBOA deflation was initiated in one of two ways: complete (100%) or partial (50%) deflation. The primary endpoint was mean difference in mean aortic pressure (MAP) compared one minute before and one minute after REBOA deflation. Secondary endpoints were mean difference in cerebral perfusion (CerPP) and coronary perfusion (CorPP) pressures (in mmHg). Data were compared using Mann-Whitney U test.

RESULTS

After ROSC the mean difference in MAP before and after deflation was 38.5 mmHg (95%CI: 17.0-60.0) with complete deflation versus 7.0 (95%CI: 1.8-12.3) with partial deflation (p = 0.006). The mean difference in CerPP was 36.3 (95%CI: 15.9-56.8) with complete deflation versus 7.1 (95%CI: 1.7-12.5) with partial deflation (p = 0.01) and the mean difference in CorPP was 38.0 (95%CI: 18.7-60.9) with complete deflation versus 6.9 (95%CI: 0.9-11.2) with partial deflation (p = 0.006).

CONCLUSION

In this porcine model of prolonged AHUP-CPR, partial REBOA balloon deflation resulted in superior hemodynamics compared with complete deflation.