You've heard of REBOA for trauma in the prehospital setting. But did you ever think there might be a place for REBOA in non-traumatic CA? In this talk from The Big Sick conference in Zermatt in 2019 Jostein Brede goes over Norwegian research to address that very question. The recorded talk and everything else from The Big Sick is up at https://scanfoam.org/

1. Trondheim
Prehospital
Research
Group (TPRG)
Resuscitative Endovascular Balloon
Occlusion of the Aorta (REBOA)
in non-traumatic out-of-hospital cardiac arrest
Jostein Rødseth Brede
Consultant anaesthesiologist and PhD-padawan
St. Olavs Hospital, 330-squadron Ørland Main Airbase, Norwegian Air Ambulance Foundation

2. Disclosures
• Partly funded by the Norwegian Air Ambulance Foundation
• No other disclosures

3. Goals for today
1. Convince you that pre-hospital REBOA might be an adjunct treatment in ACLS
2. Do so in less than 20 minutes
3. Keep you from falling asleep
4. Do not curse, fall over or make a fool of myself in any other way

7. Improving haemodynamics
• Reduction of vascular volume to distribute the cardiac output

9. (Perhaps) it’s all about the CPP
• Coronary Perfusion Pressure = aortic pressure – right atrial pressure

10. • Increase in both coronary artery flow and coronary perfusion pressure
• Increase in carotid artery flow, cerebral arterial flow and cerebral perfusion pressure
• Increased rates of return of spontaneous circulation (ROSC)

11. Any human data…?
• Only case reports

13. Prehospital feasibility and safety study
Inclusion criteria
• Age 18-75
• Non-traumatic cardiac arrest
• Less than 10 min from onset of arrest to CPR
Exclusion criteria
• Age < 18 or > 75
• Traumatic cardiac arrest, incl avalanche victims
• Pregnancy
• Hypothermia, incl drowning
• Suspected cerebal catastrophy as etiology
• Terminal disease
• Strangulation

16. Norwegian anaesthesiologist are so great. They are the
greatest. Ever. This is definitively a safe procedure to perform
in the chaotic prehospital environment. Trust me.

17. Safety monitoring program
1. Direct feedback from physician to project group
2. A post-intervention study of the ultrasound images by an experienced interventional
radiologist, the prehospital physician and project group
3. A case review using all available information by an external expert panel consisting of an
interventional radiologist, an intensivist and a prehospital physician

19. Cool. But what happens?
• Immediate rise in EtCO2
Even after almost 1 h of low-flow state !
• Immediate change in ECG-rythm
• Rates of ROSC

20. The future –
the Norwegian/Scandinavian/International RCT
• Will REBOA benefit patients with medical OHCA?
• Rates of ROSC
• Mortality
• Neurological status
• Arterial pressures
• Cerebral oximetry

21. Thank you for listening!
Go out and ski!