Head Up CPR and Aortic Occlusion to Improve Survival after Refractory Cardiac Arrest

Abstract In 2024 there will be nearly 800,000 cardiac arrest cases in the US alone. Of those only about 50,000 will have a full recovery. More than 750,000 patients will have no hope for meaningful survival. That is because there is no currently demonstrable effective treatment for refractory (R)-CA patients, the enormous subgroup of patients who invariably die annually from this leading cause of death. Depending upon the presenting rhythm, CA becomes refractory to current interventions, herein defined as a <2% survival, <10 minutes after starting conventional (C) CPR. This application is focused on a better treatment for patients with CA refractory to current management strategies, regardless of the initial rhythm presentation. Patients in R-CA cannot be resuscitated with C-CPR, defibrillation for a shockable rhythm, and vasopressor therapy, such as epinephrine, fluids, and anti-arrhythmic drugs. For over a half century we have failed to effectively treat R-CA: we have not known how. Occasionally transcutaneous cardiac pacing, ECMO and/or double sequential defibrillation can be used with some benefit for the very small percentage of patients that remain in refractory ventricular fibrillation (R-VF). However, in general these treatment strategies rarely work for R-CA, especially in patients with a non-shockable presenting rhythm that comprise 75-85% of all CA cases. However, the applicants recently observed that the addition of resuscitative endovascular balloon occlusion of the aorta (REBOA) to automated Head Up Position (AHUP) CPR resulted in a synergistic and remarkable improvement in coronary and cerebral perfusion pressures after more than 30 minutes of AHUP-CPR in pigs. This discovery suggests that REBOA + AHUP CPR may provide more definitive treatment for R-CA or, at a minimum, a bridge to more definitive therapy. Based upon these new findings, the applicants intend to test the hypothesis that the addition of REBOA to AHUP-CPR for R- CA will significantly improve brain and vital organ blood flow and increase the likelihood of neurologically- favorable survival in a well-established pre-clinical model.