Aortic balloon occlusion

Another option for cardiopulmonary resuscitation is the use of intermittent occlusion of the ascending aorta ( Tang e.L§L 1993). When the ascending aorta is occluded by a balloon proximal to the innominate artery, the entire cardiac output generated by precordial compression is directed into the coronary circuit. Consequently, coronary blood flow is dramatically increased. The technique utilizes a balloon catheter which is advanced into the ascending aorta. The balloon is inflated for 30 s during each minute of precordial compression. This augments coronary perfusion pressure with typical increases from 12 to more than 90 mmHg. Even though cerebral blood flow ceases for 30 s of each minute, no neurological deficits have been seen.

Experimentally, the success of initial resuscitation attempts and 48-h survival are impressive. Other researchers have proposed continuous occlusion of the thoracic descending aorta. However, hemodynamic efficacy is lessened when the aorta is occluded at a more distal site. As yet, no confirmation of the applicability of balloon occlusion is available.

Appropriate skill and significant time are required for aortic catheterization under the crisis conditions of cardiopulmonary resuscitation, and this produces a formidable constraint.

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