REBOA in Nontraumatic Cardiac Arrest

Nontraumatic cardiac arrest (NTCA) is a significant public health problem, affecting between 166,000 and 310,000 people annually in the United States. The probability of survival to hospital discharge remains low. Despite significant advances in care, the proportion of people surviving to hospital discharge has only minimally improved. In cardiac arrest patients, balloon occlusion of the aorta can be used in the critically ill as a method of temporizing the shock state and acting as a bridge to more definitive therapy such as the cardiac catheterization laboratory. During cardiac arrest, preclinical evidence demonstrates that the occlusion blood flow to the distal aorta effectively redirects the patient’s blood supply toward the heart and the brain, helping to preserve their function. Increased flow to these vital organs improves coronary and cerebral perfusion and oxygenation. A significant body of preclinical evidence dating back to the early 1980s supports the balloon occlusion of the aorta during NTCA as an adjunct to improve traditional advanced cardiac life support (ACLS); however, human trials have been limited to case series. Recent advances in percutaneous balloon technology have broadened this technique’s feasibility and set the stage for promising research into its role as an adjunct to ACLS.