Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging adjunct to cardiopulmonary resuscitation (CPR) that has been shown to augment proximal arterial perfusion pressures during cardiac arrest (CA). However, rapid deployment of REBOA is currently impractical in out-of-hospital settings due to the invasive nature of the technique. Accordingly, the present study was designed to evaluate the efficacy of delayed deployment of REBOA in a porcine model of CA if initial resuscitation efforts with standard CPR were unsuccessful. Methods: Swine (N=49) were subjected to 7-10 min of uninterrupted electrically-induced ventricular fibrillation CA. Standard CPR consisting of mechanical chest compressions, defibrillation, and intravenous epinephrine was subsequently performed according to ALCS guidelines for up to 20 minutes to achieve return of spontaneous circulation (ROSC; unassisted systolic blood pressure >80 mmHg for >1 min). If ROSC was not achieved after 12 minutes of standard CPR, animals were subjected to either continuation of standard CPR (n=12) or deployment of REBOA-CPR (n=12) via inflation of a balloon catheter in the descending thoracic aorta. Mean aortic pressure (MAP), coronary perfusion pressure (CPP), cerebral perfusion pressure (CePP), end-tidal CO 2 (EtCO 2 ), and regional cerebral oxygen saturation (rSO2; via near-infrared spectroscopy) were assessed throughout the resuscitation period and relative changes from the 12-minute CPR timepoint were compared between groups. Results: Continuation of standard CPR was associated with a decline in MAP (-7.7±1.8 mmHg), CPP (-2.7±0.9 mmHg), and CePP (-4.7±2.4 mmHg) over the subsequent 5-minute resuscitation period. Delayed REBOA deployment interrupted this decline, producing a transient increase in MAP (+5.8±1.6 mmHg), CPP (+2.5±1.4 mmHg), and CePP (+3.9±1.3 mmHg) during the first minute of the REBOA-CPR period. However, this was not sustained, as these parameters no longer differed between groups by the 4-minute post-REBOA deployment timepoint. Delayed REBOA was also associated with an exacerbated decline in EtCO 2 (-8.1±1.2 mmHg) compared to standard CPR (-3.3±0.9 mmHg; p< 0.01). Despite the transient increase in CePP, rSO 2 was not significantly affected by deployment of REBOA (-0.2±0.7 mmHg) compared with standard CPR (-0.1±0.9; p=0.91). ROSC was achieved in 2 of 12 animals that received delayed REBOA and 0 of 12 animals that continued to receive standard CPR. Conclusion: In a porcine model of CA, delayed deployment of REBOA after 12-minutes of unsuccessful standard CPR was associated with a transient improvement in hemodynamic parameters but did not increase cerebral oxygen saturation or dramatically improve the likelihood of achieving ROSC. These results suggest that earlier deployment of REBOA may be necessary to optimize CPR hemodynamics in patients with CA. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.
Yots et al. (Fri,) studied this question.
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