Skip to main content

Table 2 Experience of REBOA in the pre-hospital setting

From: Resuscitative endovascular balloon occlusion of the aorta in civilian pre-hospital care: a systematic review of the literature

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

  1. ACLS advanced cardiovascular life support, CFA common femoral artery, CPR cardiopulmonary resuscitation, ECPR extracorporeal cardiopulmonary resuscitation, ER emergency room, eFAST extended focused assessment with sonography in trauma, NCTH non-compressible torso hemorrhage, NCPH non-compressible pelvic hemorrhage, OHCA out-of-hospital cardiac arrest, REBOA resuscitative balloon occlusion of the aorta, ROSC recuperation of spontaneous circulation, SFA superficial femoral artery