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Is there a place for REBOA in cardiac arrest? - Prehospital Research Support Site

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Is there a place for REBOA in cardiac arrest? - Prehospital Research Support Site Home About Resources Links Forum Contact Us Menu Home About Resources Links Forum Contact Us Is there a place for REBOA in cardiac arrest? Is there a place for REBOA in cardiac arrest?by Christopher Foerster. Last modified: 09/01/16 Print PDF   Foerster CR1, Turgulov A2. Prehospital endovascular thrombosis of the aorta is now a technically feasible strategy for improving haemodynamics in CPR. Resuscitation. 2015 Aug;93:e25. PMID: 26049132.   The CHEER trial that showed that patients with refractory VF cardiac trespassing who previously would have been pronounced sufferer in the field can survive with a good neurological outcome if they receive constructive circulatory support and definitive intervention in hospital. This suggests that we need to rethink our tideway to resuscitation to consider whether we can make CPR increasingly constructive to modernize the endangerment getting our patients to definitive superintendency while still potentially viable when defibrillation has been unsuccessful. This is the thought that led to the proposal recently published in Resuscitation that the resuscitative endovascular unlearn thrombosis of the aorta (REBOA) technique could be useful in prehospital medical cardiac arrest. By occluding diffusion to non-vital areas of the soul and improving perfusion to the heart and brain, it may someday play a role in the treatment of refractory cardiac arrest. There are barriers to seeing this idea implemented, plane if the intended physiological impact is seen. These are primarily technical challenges having to do with the need to unzip femoral street wangle for endovascular thrombosis of the aorta, which to our knowledge has not yet been washed-up during cardiac arrest. Widespread use of the technique would moreover be limited by the need to have practitioners in the field who are competent in the technique and perform it commonly unbearable to maintain the skill. Despite these challenges, this novel resuscitation strategy is worth exploring remoter to determine feasibility, later to be followed by an towage of efficacy if it is found to be technically feasible. Please read the full letter and share your thoughts in the comments below. Link to letter: http://www.resuscitationjournal.com/article/S0300-9572(15)00230-0/fulltext References   1. Foerster CR1, Turgulov A2. Prehospital endovascular thrombosis of the aorta is now a technically feasible strategy for improving haemodynamics in CPR. Resuscitation. 2015 Aug;93:e25. PMID: 26049132. The pursuit two tabs transpiration content below.BioLatest Posts Christopher Foerster Chris is a paramedic with Lambton EMS in Ontario, Canada and is zippy in paramedic education and research. Latest posts by Christopher Foerster (see all) Paramedic students…write something! - 28/04/16 Is there a place for REBOA in cardiac arrest? - 09/01/16 Tags: prehospital, REBOA, trauma 2 thoughts on “Is there a place for REBOA in cardiac arrest?” Zaf Qasim (@emeddoc) says: 10/01/16 at 04:50 Christopher A unconfined topic tropical to my heart! I think certainly the unprepossessing data is very compelling, and as you say shows unconfined resurgence in cardio-cerebral perfusion in those models. I think as catheter technology evolves, and as we recently discussed in our paper (http://www.resuscitationjournal.com/article/S0300-9572(15)00398-6/abstract), REBOA will have a place in non-traumatic trespassing potentially as a underpass to ECMO or other techniques. I think what will be particularly fascinating is the incubation of work by people like Dr Jim Manning on selective aortic wily perfusion (SAAP) and incorporating that into cardiac trespassing algorithms. The future is very exciting! You mention in your piece the technical aspects of femoral access. I think this is a hair-trigger point, and certainly with the currently used equipment in North America, this emphasizes the unconfined importance of towardly training. The technology here is evolving and will soon indulge the use of smaller sheaths and catheters, but this is still a little ways away. Internationally however they are once using smaller sheaths, and we can certainly all learn from their experience. Additionally, although REBOA placement in trespassing in the prehospital setting has not yet been reported (or to my knowledge been done), we have washed-up it in hospital in traumatic cardiac arrest. In the trespassing state, the street is primarily accessed via a groin cutdown technique, although ultrasound can moreover be utilized. Thanks for your contribution to this topic. Zaf Reply Chris Foerster says: 14/01/16 at 19:58 Thank you very much for your comments and for sharing a link to your review, Dr. Qasim. The future certainly is exciting! Did you wits any unexpected challenges in using the REBOA in your patient in traumatic cardiac arrest? Anuar and I have moreover not yet heard of a specimen of REBOA placement in a patient in cardiac trespassing in the prehospital setting but we are interested in the possibility of this taking place. It seemed like our European colleagues might be the weightier situated for this with their increasingly widespread use of hair-trigger superintendency physicians in the field than we often have in North America. Do you visualize that there might be an American EMS system where there is uncontrived field involvement of physicians who would be worldly-wise to wield this technique for a patient in medical cardiac arrest? Thank you then for taking the time to share your insights! 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