The administration of
epinephrine in the management of non-traumatic
cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during
cardiopulmonary resuscitation (
CPR) in a swine model of non-traumatic
cardiac arrest.
RESULTS: Anesthetized pigs were instrumented and submitted to
ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical
CPR device, animals were randomly submitted to either REBOA or
epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (
Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After
epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to
epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After
resuscitation, CBF remained lower in the
epinephrine group as compared to REBOA, but it did not achieve statistical significance.
CONCLUSIONS: During
CPR, REBOA is as efficient as
epinephrine to facilitate ROSC. Unlike
epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during
CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic
cardiac arrest.