Study | Type of study | Participants | Interventions | Outcomes | Conclusions |
---|---|---|---|---|---|
Sadek 2016 [11] (United Kingdom) | Case report | N = 1 A 32-yo severely injured patient, with exsanguinating hemorrhage secondary to multiple pelvic fractures | Zone III REBOA, insertion under ultrasound guidance Introducer Sheath 8 Fr and Balloon Catheter 7 Fr (14 mm) | Primary outcomes: Feasibility: REBOA was successfully performed Survival: The patient survived to hospital discharge (52 days) without neurological impairment Compliance to eligibility: N/A Secondary outcomes: There were no complications and CPR was not required ROSC: N/A | Prehospital REBOA is possible and may contribute to manage severe NCTH |
Lendrum 2018 [12] (United Kingdom) | Case series | N = 21 Patients with NCPH and hemodynamic instability: - 19 from traumatic origin - 2 from non-traumatic origin | Zone III REBOA, insertion under ultrasound guidance Introducer Sheath 7 Fr and Balloon Catheter 6 Fr (13 mm) A pre-alert call was made to the receiving major trauma center | Primary outcomes: Feasibility: 15 (71%) patients out of 21 attempts underwent a successful REBOA procedure - Traumatic: 13/19 (68%) - Non-traumatic: 2 out of 2 Survival: 60% (9/15) survived to hospital discharge: - Traumatic: 8/13 (62%) - Non-traumatic: 1 out of 2 Compliance to eligibility: Not reported Secondary outcomes: - CPR was not required - ROSC: 1 non-traumatic patient in cardiac arrest achieved ROSC following REBOA - Early arterial thrombosis following REBOA was present in 77% (10/13) of trauma patients - Other complications were amputation, SFA cannulation, inadvertent zone II placement, and iatrogenic dissection of the CFA to distal aorta | Prehospital REBOA is a feasible resuscitation strategy for patients with NCTH in a physician-led pre-hospital care system Pre-hospital Zone III REBOA may reduce the risk of pre-hospital hypovolemic cardiac arrest and early death due to exsanguination Distal arterial thrombus formation is common and should be expected and actively managed |
Brede 2019[15] (Norway) | Prospective cohort study | N = 15 Patients with non-traumatic OHCA, aged 18 to 75 years and in which CPR was initiated in less than 10 min after onset of arrest | Zone I REBOA. insertion under ultrasound guidance The Introducer Sheath size was not reported, and the Balloon Catheter was 7 Fr (20 mm) All patients received CPR using a chest compression machine to standardize cardiac massage | Primary outcomes: Feasibility: Prehospital REBOA was successfully performed in the 10 attempted procedures (100%) - 8 in the first attempt - 2 in the second Survival: 30% (3/10) survived to hospital admission and 1 to the 30-day follow-up Compliance to eligibility: Prehospital REBOA was attempted in 10 of 15 (66%) eligible patients Secondary outcomes: All patients received CPR and there were no complications ROSC: 6/10 patients (60%) achieved ROSC | This study shows the feasibility and safety of prehospital REBOA as an adjunct treatment to non-traumatic OHCA, without interfering with the ACLS quality |
Brede 2021 [17] (Norway) | Prospective cohort study | N = 17 Patients with non-traumatic OHCA, aged 18 to 75 years and in which bystander CPR was initiated in less than 10 min after onset of arrest | Zone I REBOA. insertion under ultrasound guidance The Introducer Sheath size was not reported, and the Balloon Catheter was 7 Fr (20 mm) All patients were endotracheally intubated, manually ventilated and received mechanical chest compressions | Primary outcomes: Feasibility: Prehospital REBOA was successfully performed at first cannulation attempt in the 7 attempted procedures (100%). However, 2 patients were excluded from the study due to extra-arterial placement of the peripheral arterial line Survival: 20% (1/5) survived to hospital admission but not to the 30-day follow-up Compliance to eligibility: Prehospital REBOA was attempted in 7 of 17 (41%) eligible patients Secondary outcomes: All patients received CPR and no complications were reported ROSC: 2/5 patients (40%) achieved ROSC | This study suggests that REBOA as an adjunct treatment during resuscitation may significantly increase the peripheral arterial blood pressures and it is likely that this indicates improved central aortic blood pressure |
Gamberini 2021 [16] (Italy) | Case series | N = 20 Patients with refractory OHCA (defined as lack of ROSC after 15 min of CPR, in the absence of hypothermia) who were not eligible for ECPR REBOA was placed in the ER (n = 12) or pre-hospital setting (n = 8). The later were: - 4 trauma patients - 4 non-trauma patients | Zone I REBOA. insertion under ultrasound guidance Initially Introducer Sheath 8 Fr and Balloon Catheter 8 Fr (30 mm). After June 2019, Introducer Sheath 7 Fr and Balloon Catheter—Fr (32 mm) Non-trauma patients underwent cardiothoracic and abdominal ultrasound prior to REBOA Trauma patients underwent bilateral thoracostomy, eFAST and pericardiocentesis (if necessary) prior to REBOA | Primary outcomes: Feasibility: Prehospital REBOA was successfully performed in the 8 attempted procedures (100%) Survival: There were no survivors Compliance to eligibility: Not reported Secondary outcomes: All patients received CPR and no complications were reported ROSC: 3/8 patients (38%) achieved ROSC - Traumatic: 1/4 (25%) - Non-traumatic: 2/4 (50%) | This series of mixed cases suggests that a transient ROSC can be achieved, despite suffering from refractory cardiac arrests with long low flow times. However, survival may be influenced by the long times to ROSC and late application of the technique during CPR |