Use of resuscitative balloon occlusion of the aorta in a swine model of prolonged cardiac arrest

Mohamad Hakam Tiba; Brendan M McCracken; Brandon C Cummings; Carmen I Colmenero; Chandler J Rygalski; Cindy H Hsu; Thomas H Sanderson; Brahmajee K Nallamothu; Robert W Neumar; Kevin R Ward

doi:10.1016/j.resuscitation.2019.05.010

Use of resuscitative balloon occlusion of the aorta in a swine model of prolonged cardiac arrest

Resuscitation. 2019 Jul:140:106-112. doi: 10.1016/j.resuscitation.2019.05.010. Epub 2019 May 20.

Affiliations

¹ University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States. Electronic address: tibam@med.umich.edu.
² University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States. Electronic address: bmccrac@med.umich.edu.
³ University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States. Electronic address: cummingb@med.umich.edu.
⁴ University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States. Electronic address: cico@med.umich.edu.
⁵ University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Molecular and Integrative Physiology, United States. Electronic address: rygalski.5@buckeyemail.osu.edu.
⁶ University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States; University of Michigan, Department of Surgery. Electronic address: hcindy@med.umich.edu.
⁷ University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Molecular and Integrative Physiology, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States. Electronic address: thsand@med.umich.edu.
⁸ University of Michigan, Department of Internal Medicine, Division of Cardiology, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States. Electronic address: bnallamo@med.umich.edu.
⁹ University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States. Electronic address: neumar@med.umich.edu.
¹⁰ University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Biomedical Engineering, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States. Electronic address: keward@med.umich.edu.

PMID: 31121206
PMCID: PMC7157798
DOI: 10.1016/j.resuscitation.2019.05.010

Abstract

Aim: We examined the use of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter during cardiopulmonary resuscitation (CPR) after cardiac arrest (CA) to assess its effect on haemodynamics such as coronary perfusion pressure (CPP), common carotid artery blood flow (CCA-flow) and end-tidal CO₂ (PetCO₂) which are associated with increased return of spontaneous circulation (ROSC).

Methods: Six male swine were instrumented to measure CPP, CCA-Flow, and PetCO₂. A 7Fr REBOA was advanced into zone-1 of the aorta through the femoral artery. Ventricular fibrillation was induced and untreated for 8 min. CPR (manual then mechanical) was initiated for 24 min. Continuous infusion of adrenaline (epinephrine) was started at minute-4 of CPR. The REBOA balloon was inflated at minute-16 for 3 min and then deflated/inflated every 3 min for 3 cycles. Animals were defibrillated up to 6 times after the final cycle. Animals achieving ROSC were monitored for 25 min.

Results: Data showed significant differences between balloon deflation and inflation periods for CPP, CCA-Flow, and PetCO₂ (p < 0.0001) with an average difference (SD) of 13.7 (2.28) mmHg, 15.5 (14.12) mL min^-1 and -4 (2.76) mmHg respectively. Three animals achieved ROSC and had significantly higher mean CPP (54 vs. 18 mmHg), CCA-Flow (262 vs. 135 mL min^-1) and PetCO₂ (16 vs. 8 mmHg) (p < 0.0001) throughout inflation periods than No-ROSC animals. Aortic histology did not reveal any significant changes produced by balloon inflation.

Conclusion: REBOA significantly increased CPP and CCA-Flow in this model of prolonged CA. These increases may contribute to the ability to achieve ROSC.

Keywords: Aorta; Cardiac arrest; Coronary perfusion pressure; REBOA; Return of spontaneous circulation.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Animals
Aorta*
Balloon Occlusion*
Blood Pressure
Carbon Dioxide / blood
Cardiopulmonary Resuscitation / methods*
Carotid Arteries
Coronary Circulation
Disease Models, Animal
Heart Arrest / therapy*
Regional Blood Flow
Swine
Tidal Volume

Substances

Carbon Dioxide

Grants and funding

K12 HL133304/HL/NHLBI NIH HHS/United States