Non-Occlusive Mesenteric Ischemia After Resuscitative Endovascular Balloon Occlusion of the Aorta for Out-of-Hospital Cardiac Arrest due to Massive Gastrointestinal Bleeding

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a method of controlling intra-abdominal bleeding in case of hemorrhagic shock and an adjunct to improve traditional advanced cardiac life support in nontraumatic cardiac arrest. Partial REBOA is proposed as an alternative method that regulates low volume continuous blood flow across the area of occlusion with the aim of minimizing ischemia-reperfusion injury. Case Presentation: An 82-year-old male suffered an out-of-hospital cardiac arrest due to massive gastric bleeding. He was initially resuscitated with partial REBOA but died of non-occlusive mesenteric ischemia (NOMI). The possible causes of NOMI were the patient’s age, the low flow state with prolonged cardiopulmonary resuscitation, the lower proximal-to-distal gradient of partial REBOA, and the longer time of total occlusion. Conclusion: Further studies may be required to determine the optimal distal pressure during partial REBOA to limit the burden of mesenteric ischemia.