Aims and Objectives In the UK, cardiac arrest kills tens of thousands of people each year. Survival rates have shown little improvement in recent years with only 1 in 10 patients surviving. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been proposed as an adjunct in the management of non-traumatic cardiac arrest (NTCA). This review had two aims: delineate the physiological effects of aortic occlusion in NTCA and report the association between aortic occlusion and clinical outcomes in NTCA.

Method and Design We performed a literature review in December 2023 using Pubmed, Embase and Scopus databases according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Search terms included aortic occlusion (AO), REBOA and cardiac arrest. Only human studies in non-traumatic, non-haemorrhagic cardiac arrest were included. This returned 404 results. After screening, 12 publications met the inclusion criteria of which six were detailed pilot, feasibility and larger observational studies and the rest were case reports.

Results and Conclusion Trials varied in physiological outcome measures. The effects of AO in NTCA included statistically significant increases in end-tidal CO2 (5 studies), mean arterial pressure (2 studies), coronary perfusion pressure (1 study) and cerebral oxygenation (1 study) (table 1). A high rate of ROSC was observed at 45.9% across all studies despite a markedly long average time from dispatch to AO of around 53 minutes. The association between AO and patient-focused clinical outcomes was not as profound, with high ROSC rates rarely translating into survival to discharge, with a rate of 1.6% across all studies. Patients frequently re-arrested post-deflation.

REBOA in NTCA shows promising physiological benefits and is associated with significant improvements in intra-arrest physiology. However, the evidence is currently limited and clinical studies do not demonstrate survival benefit. More informative trial designs are justified by anticipated clinical benefits to determine the role of AO in managing NTCA.