Endovascular resuscitation: an expert practice review

Area of Science:

• Emergency Medicine
• Critical Care
• Cardiovascular Interventions

Background:

• Endovascular resuscitation (EVR) encompasses novel therapies for shock and cardiac arrest.
• These techniques aim to control hemorrhage and provide mechanical circulatory support.
• Growing adoption faces controversies regarding risk, efficacy, and implementation.

Purpose of the Study:

• To provide emergency physicians with an overview of EVR principles and practice.
• To review EVR rationale and techniques for out-of-hospital cardiac arrest and non-compressible hemorrhage.
• To describe escalating EVR interventions: resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion, and extracorporeal cardiopulmonary resuscitation.

Main Methods:

• Practice review based on case scenarios.
• Review of rationale, vascular access, physiology, technique, efficacy, and safety.
• Focus on three escalating endovascular interventions.

Main Results:

• Discussion of vascular access as a critical initial step.
• Detailed description of resuscitative endovascular balloon occlusion of the aorta.
• Overview of selective aortic arch perfusion and extracorporeal cardiopulmonary resuscitation.

Conclusions:

• Emergency physicians need to understand EVR for critically ill patients.
• EVR offers a bridge to definitive treatment in shock and cardiac arrest.
• Knowledge of EVR is essential for advocacy and future implementation.