Resuscitative endovascular balloon occlusion of the aorta may not improve outcomes in adults with non-traumatic out-of-hospital cardiac arrest

1. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to advanced life support (ALS) does not improve rates of return of spontaneous circulation (ROSC) in adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA).

Evidence Rating Level: 1 (Excellent)

OHCA remains associated with extremely high mortality, with most patients not achieving ROSC, and only 10% of patients surviving to hospital discharge. REBOA involves temporarily occluding the aorta with an inflatable balloon catheter inserted percutaneously through the femoral artery and is primarily used to control life-threatening subdiaphragmatic hemorrhage. However, studies including REBOA as an adjunct to ALS have shown improved cerebral and coronary perfusion and ROSC rates. This study sought to evaluate the effectiveness of prehospital REBOA as an adjunct to ALS in patients with non-traumatic OHCA. Adult patients aged 18-80 years with non-traumatic OHCA were randomly assigned to receive ALS (control; n = 91; median [IQR] age, 69 [58-74] years; 26% female) or ALS combined with REBOA (intervention; n = 88; median [IQR] age, 68 [59-74.5] years; 22% female). 25 patients (28%) in the intervention group and 24 patients (25%) in the control group achieved sustained ROSC (adjusted risk difference (aRD) 1.8% [-11, 15, 95% CI], p = 0.78). There were no significant differences in the proportion of patients in the intervention vs. control group who achieved a modified Rankin Scale score of 0-3 (6% vs. 3%, p = 0.47), mean left ventricular ejection fraction (39% vs. 33%, p = 0.23), or survival at 30 days (7% vs. 7%, p = 0.99). While REBOA as an adjunct to ALS was feasible, it did not seem to significantly improve rates of ROSC or overall survival compared to ALS alone.

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