What question did this study set out to answer?

To evaluate the hemodynamic effects of partial versus complete deflation of REBOA after ROSC following CPR.

May 29, 2026Open Access

Physiological Changes After Deflation of Resuscitative Endovascular Balloon Occlusion of the Aorta following Automated Head-up Position Cardiopulmonary Resuscitation: a Post-hoc Analysis

NSN. SegondInstitut polytechnique de Grenoble JMJ. MooreUniversity of Minnesota PPP. PourzandLehigh Valley Hospital-Pocono

Key Points

To evaluate the hemodynamic effects of partial versus complete deflation of REBOA after ROSC following CPR.
Conducted in a porcine model (N=20) post-ventricular fibrillation (10 minutes) with AHUP-CPR.
REBOA balloon inflated for 36 minutes; deflation was complete or partial after ROSC initiation.
Mean differences in aortic, cerebral, and coronary pressures compared using Mann-Whitney U test.
Complete REBOA deflation resulted in a mean MAP change of 38.5 mmHg (95%CI: 17.0 to 60.0, p=0.006) compared to 7.0 mmHg with partial deflation (95%CI: 1.8 to 12.3).
Cerebral perfusion pressure showed mean differences of 36.3 mmHg (95%CI: 15.9 to 56.8, p=0.01) for complete deflation versus 7.1 mmHg (95%CI: 1.7 to 12.5) for partial.
Coronary perfusion pressure changes were 38.0 mmHg (95%CI: 18.7 to 60.9, p=0.006) for complete and 6.9 mmHg (95%CI: 0.9 to 11.2) for partial deflation.

Abstract

Background Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and the automated head-up position (AHUP) have increasingly both been separately reported during cardiopulmonary resuscitation (CPR). The optimal hemodynamic management of REBOA balloon deflation after the return of spontaneous circulation (ROSC) is unknown. We hypothesized that partial deflation of REBOA rather than full deflation after ROSC would result in better hemodynamic parameters. Methods After 10 minutes of untreated ventricular fibrillation, AHUP-CPR was performed on 20 pigs (weighting ∼ 40kgs). After 36 minutes, a REBOA balloon was inflated. After ROSC (13 pigs) REBOA deflation was initiated in one of two ways: complete (100%) or partial (50%) deflation. The primary endpoint was mean difference in mean aortic pressure (MAP) compared one minute before and one minute after REBOA deflation. Secondary endpoints were mean difference in cerebral perfusion (CerPP) and coronary perfusion (CorPP) pressures (in mmHg). Data were compared using Mann-Whitney U test. Results After ROSC the mean difference in MAP before and after deflation was 38.5 mmHg (95%CI: 17.0 to 60.0) with complete deflation versus 7.0 (95%CI: 1.8 to 12.3) with partial deflation (p=0.006). The mean difference in CerPP was 36.3 (95%CI: 15.9 to 56.8) with complete deflation versus 7.1 (95%CI: 1.7 to 12.5) with partial deflation (p=0.01) and the mean difference in CorPP was 38.0 (95%CI: 18.7 to 60.9) with complete deflation versus 6.9 (95%CI: 0.9 to 11.2) with partial deflation (p=0.006). Conclusion In this porcine model of prolonged AHUP-CPR, partial REBOA balloon deflation resulted in superior hemodynamics compared with complete deflation.

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