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Study Objectives: The objective of this study is to assess the feasibility of using a disposable pressure transducer to obtain mean aortic pressure (MAP) during CPR and placement of resuscitative endovascular balloon occlusion of the aorta (REBOA) within an emergency medicine (EM)-initiated multi-disciplinary protocol in non-traumatic out-of-hospital cardiac arrest (OHCA) Methods: During medical cardiac arrest obtaining a MAP >55 mmHg has been associated with greater survivorship Use of an arterial line and monitor requires calibration which may demand additional personnel resources during management of a cardiac arrest A disposable pressure transducer (Centurion Compass® Pressure Monitor) is able to detect and display mean aortic pressure within seconds of placement onto an arterial line We are conducting a single-arm early feasibility study of REBOA initiated in the emergency department (ED) for OHCA using an Food and Drug Administration (FDA) investigational device approval with an exception from informed consent During this study we are evaluating the feasibility of using disposable pressure transducers to determine MAP during CPR and REBOA placement Our goal is to enroll 20 patients as part of this feasibility study Results: Two of the initial twenty patients were enrolled between January and February 2020, with a temporary pause in enrollment due to the COVID pandemic from March to July 2020 A disposable pressure transducer was used to obtain continuous MAPs in both patients Our initial patient was a 77-year-old man who presented in refractory ventricular fibrillation and we were able to obtain pre- and post- REBOA inflation MAPs After inflation of the aortic balloon, investigators noted immediate improvements in mean aortic pressure (MAP) (37 to 50 mmHg) The second patient, a 63-year-old man, underwent successful REBOA placement with similar improvements in MAP (22 to 50 mmHg) Investigators were also able to identify large differences in MAPs generated between individuals performing CPR, noting MAPs between 34 and 50 between multiple CPR providers despite visually adequate chest depth compressions Conclusion: The use of disposable pressure transducers during CPR and REBOA in OHCA to rapidly obtain MAP may be feasible Further, use of these transducers may assist in guiding CPR to achieve target MAPs during cardiac arrest More research is needed to determine what impact a targeted MAP has on patient outcomes, and whether or not it correlates with changes in end-tidal carbon dioxide (ETCO2)
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Annals_of_Emergency_Medicine
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176 Use of Disposable Pressure Transducer With Resuscitative Endovascular Balloon Occlusion of the Aorta in Medical Cardiac Arrest
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