The Resus Tracks: Medical Arrest REBOA with Zack Shinar! #FOAMed, #FOAMcc

So I’ve had the pleasure of knowing Zack for a few years now, ever since he and Joe Bellezzo (the EDECMO Team – along with Scott Weingart) came up to Montreal to teach at CCUS 2013 where they first told us about ECPR. I was instantly hooked, and after the CHEER Study came out in 2014, have been on the path to get this going in my shop, Santa Cabrini Hospital in Montreal, Canada. A tall order for a Canadian community hospital, but hey, I’m in the business of saving lives, and always felt and will feel that any patient crossing thru into a hospital I work in should get the best care that my team and I can possibly put together.

I think any invasive procedure is within the reach of any dedicated resuscitationist with reasonable procedural experience, with the proper training, and inserting ECMO cannulae, and Joe and Zack, a couple of awesome ED docs, showed this clearly. Its use is now spreading, and though there are – as always – many pundits, there is little question that this technique can save lives – the key being selection and subsequent management.

So here Zack tells me of another potential use for a tool I really like. We have recently acquired this technology and I’m looking forward to using it. REBOA is a tool used to control bleeding – a non-surgical cross-clamping of the aorta. But here, we explore how it might be used in another, more common setting… and I love the physiology of it!

Here you go – and apologize if it may be a bit choppy as we had connectivity issues, but I think Zack’s message comes out nonetheless!

 

This is what a REBOA looks like:

You can see how aortic occlusion beyond the takeoff of the left subclavian will concentrate CPR-generated blood flow to coronaries, cerebral circulation and arms, none being “lost” to the viscera and lower extremities. This makes ROSC more likely by improving coronary perfusion pressure and may improve neurological outcome by improving cerebral perfusion pressure.

 

Oh yeah, and anyone who enjoyed this, going beyond the cutting edge, don’t miss H&R2020, whose ethos is just that. Physiology and going beyond the cutting edge. A REBOA workshop will be part of the Resus Toolbox – one of the pre-conf courses!

cheers

 

Philippe

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