A Protocol for the ERICA-ARREST Feasibility Study of Emergency Resuscitative Endovascular Balloon Occlusion of the Aorta in Out-of-Hospital Cardiac Arrest

Overview

Journal Resusc Plus

Date 2024 Jul 8

PMID 38974930

Authors

Shadman Aziz

Jon Barratt

Noamaan Wilson-Baig

Kate Lachowycz

Rob Major

Ed B G Barnard

Paul Rees

Affiliations

Soon will be listed here.

Abstract

Background: Fewer than one in ten out-of-hospital cardiac arrest (OHCA) patients survive to hospital discharge in the UK. For prehospital teams to improve outcomes in patients who remain in refractory OHCA despite advanced life support (ALS); novel strategies that increase the likelihood of return of spontaneous circulation, whilst preserving cerebral circulation, should be investigated. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has been shown to improve coronary and cerebral perfusion during cardiopulmonary resuscitation. Early, prehospital initiation of REBOA may improve outcomes in patients who do not respond to standard ALS. However, there are significant clinical, technical, and logistical challenges with rapidly delivering prehospital REBOA in OHCA; and the feasibility of delivering this intervention in the UK urban-rural setting has not been evaluated.

Methods: The Emergency Resuscitative Endovascular Balloon Occlusion of the Aorta in Out-of-Hospital Cardiac Arrest (ERICA-ARREST) study is a prospective, single-arm, interventional feasibility study. The trial will enrol 20 adult patients with non-traumatic OHCA. The primary objective is to assess the feasibility of performing Zone I (supra-coeliac) aortic occlusion in patients who remain in OHCA despite standard ALS in the UK prehospital setting. The trial's secondary objectives are to describe the hemodynamic and physiological responses to aortic occlusion; to report key time intervals; and to document adverse events when performing REBOA in this context.

Discussion: Using compressed geography, and targeted dispatch, alongside a well-established femoral arterial access programme, the ERICA-ARREST study will assess the feasibility of deploying REBOA in OHCA in a mixed UK urban and rural setting.Trial registration.ClinicalTrials.gov (NCT06071910), registration date October 10, 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06071910.

References

Price J, Lachowycz K, Steel A, Moncur L, Major R, Barnard E . Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM). Scand J Trauma Resusc Emerg Med. 2022; 30(1):44. PMC: 9264686. DOI: 10.1186/s13049-022-01032-2. View

Gedeborg R, Silander H, Rubertsson S, Wiklund L . Cerebral ischaemia in experimental cardiopulmonary resuscitation--comparison of epinephrine and aortic occlusion. Resuscitation. 2001; 50(3):319-29. DOI: 10.1016/s0300-9572(01)00350-1. View

Yannopoulos D, McKnite S, Aufderheide T, Sigurdsson G, Pirrallo R, Benditt D . Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest. Resuscitation. 2005; 64(3):363-72. DOI: 10.1016/j.resuscitation.2004.10.009. View

Kern K, Hilwig R, Ewy G . Retrograde coronary blood flow during cardiopulmonary resuscitation in swine: intracoronary Doppler evaluation. Am Heart J. 1994; 128(3):490-9. DOI: 10.1016/0002-8703(94)90622-x. View

Vopelius-Feldt J, Brandling J, Benger J . Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest. Resuscitation. 2017; 114:40-46. DOI: 10.1016/j.resuscitation.2017.02.018. View

Daley J, Morrison J, Sather J, Hile L . The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest. Am J Emerg Med. 2017; 35(5):731-736. DOI: 10.1016/j.ajem.2017.01.010. View

Nerla R, Webb I, MacCarthy P . Out-of-hospital cardiac arrest: contemporary management and future perspectives. Heart. 2015; 101(18):1505-16. DOI: 10.1136/heartjnl-2014-306961. View

Brede J, Skjaerseth E, Klepstad P, Nordseth T, Kruger A . Changes in peripheral arterial blood pressure after resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic cardiac arrest patients. BMC Emerg Med. 2021; 21(1):157. PMC: 8672343. DOI: 10.1186/s12873-021-00551-y. View

Soar J, Bottiger B, Carli P, Couper K, Deakin C, Djarv T . European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021; 161:115-151. DOI: 10.1016/j.resuscitation.2021.02.010. View

10.

Kalogeropoulos A, Kennon S, Karamasis G, Smith E, Rees P . Successful Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction During Resuscitation From Cardiac Arrest by Combined Mechanical Chest Compressions and Intra-aortic Balloon Pump Counterpulsation: A Case Report. A A Pract. 2018; 10(12):323-326. DOI: 10.1213/XAA.0000000000000707. View

11.

Jang D, Lee D, Jo Y, Park S, Oh Y, Im C . Resuscitative endovascular occlusion of the aorta (REBOA) as a mechanical method for increasing the coronary perfusion pressure in non-traumatic out-of-hospital cardiac arrest patients. Resuscitation. 2022; 179:277-284. DOI: 10.1016/j.resuscitation.2022.07.020. View

12.

Edmunds C, Lachowycz K, McLachlan S, Downes A, Smith A, Major R . Nine golden codes: improving the accuracy of Helicopter Emergency Medical Services (HEMS) dispatch-a retrospective, multi-organisational study in the East of England. Scand J Trauma Resusc Emerg Med. 2023; 31(1):27. PMC: 10258975. DOI: 10.1186/s13049-023-01094-w. View

13.

Rubertsson S, Bircher N, Alexander H . Effects of intra-aortic balloon occlusion on hemodynamics during, and survival after cardiopulmonary resuscitation in dogs. Crit Care Med. 1997; 25(6):1003-9. DOI: 10.1097/00003246-199706000-00018. View

14.

Nozari A, Rubertsson S, Wiklund L . Improved cerebral blood supply and oxygenation by aortic balloon occlusion combined with intra-aortic vasopressin administration during experimental cardiopulmonary resuscitation. Acta Anaesthesiol Scand. 2000; 44(10):1209-19. DOI: 10.1034/j.1399-6576.2000.441005.x. View

15.

Nozari A, Rubertsson S, Wiklund L . Intra-aortic administration of epinephrine above an aortic balloon occlusion during experimental CPR does not further improve cerebral blood flow and oxygenation. Resuscitation. 2000; 44(2):119-27. DOI: 10.1016/s0300-9572(00)00132-5. View

16.

Perkins G, Ji C, Deakin C, Quinn T, Nolan J, Scomparin C . A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018; 379(8):711-721. DOI: 10.1056/NEJMoa1806842. View

17.

Deakin C, Barron D . Haemodynamic effects of descending aortic occlusion during cardiopulmonary resuscitation. Resuscitation. 1996; 33(1):49-52. DOI: 10.1016/s0300-9572(96)00992-6. View

18.

Morrison J, Stannard A, Midwinter M, Sharon D, Eliason J, Rasmussen T . Prospective evaluation of the correlation between torso height and aortic anatomy in respect of a fluoroscopy free aortic balloon occlusion system. Surgery. 2014; 155(6):1044-51. DOI: 10.1016/j.surg.2013.12.036. View

19.

Sedrakyan A, Campbell B, Merino J, Kuntz R, Hirst A, McCulloch P . IDEAL-D: a rational framework for evaluating and regulating the use of medical devices. BMJ. 2016; 353:i2372. DOI: 10.1136/bmj.i2372. View

20.

Tang W, Weil M, Noc M, Sun S, Gazmuri R, Bisera J . Augmented efficacy of external CPR by intermittent occlusion of the ascending aorta. Circulation. 1993; 88(4 Pt 1):1916-21. DOI: 10.1161/01.cir.88.4.1916. View