ABSTRACT
Background: Fewer than one in ten out-of-hospital cardiac arrest (OHCA) patients survive to hospital discharge in the UK. For prehospital teams to improve outcomes in patients who remain in refractory OHCA despite advanced life support (ALS); novel strategies that increase the likelihood of return of spontaneous circulation, whilst preserving cerebral circulation, should be investigated. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has been shown to improve coronary and cerebral perfusion during cardiopulmonary resuscitation. Early, prehospital initiation of REBOA may improve outcomes in patients who do not respond to standard ALS. However, there are significant clinical, technical, and logistical challenges with rapidly delivering prehospital REBOA in OHCA; and the feasibility of delivering this intervention in the UK urban-rural setting has not been evaluated. Methods: The Emergency Resuscitative Endovascular Balloon Occlusion of the Aorta in Out-of-Hospital Cardiac Arrest (ERICA-ARREST) study is a prospective, single-arm, interventional feasibility study. The trial will enrol 20 adult patients with non-traumatic OHCA. The primary objective is to assess the feasibility of performing Zone I (supra-coeliac) aortic occlusion in patients who remain in OHCA despite standard ALS in the UK prehospital setting. The trial's secondary objectives are to describe the hemodynamic and physiological responses to aortic occlusion; to report key time intervals; and to document adverse events when performing REBOA in this context. Discussion: Using compressed geography, and targeted dispatch, alongside a well-established femoral arterial access programme, the ERICA-ARREST study will assess the feasibility of deploying REBOA in OHCA in a mixed UK urban and rural setting.Trial registration.ClinicalTrials.gov (NCT06071910), registration date October 10, 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06071910.
ABSTRACT
This article was migrated. The article was marked as recommended. In a recent MedEdPublish article by Keenan and Jennings (2017), I was interested in why some Life Sciences are under-represented in the wider medical literature. The article states anatomy to be the dominant discipline within medical schools and describes a close link between anatomy and educational research with the presence of an "established medical education research community and social media community linked to anatomy". Unfortunately, this does not appear to be the case with other scientific disciplines. In my career, I have been fortunate to have studied both Pharmacy and Medicine as an undergraduate. I also possess an MSc in Clinical Pharmacy and am undertaking an MSc in Clinical Research. I have seen at first-hand how integral the Life Sciences are in the practice of Pharmacy and Medicine. It is therefore necessary that, like anatomy, other Life Sciences should enjoy a similar commitment to "maintaining a scholarly approach to teaching and learning ( Keenan and Jennings, 2017). Currently, I am an Academic Clinical Registrar in Anaesthesia working in the North-West. I am part funded by the National Institute for Health Research (NIHR). Considering my background, I would like to share a personal reflection of my experience of undergraduate training and professional life. I will compare the undergraduate teaching styles I experienced whilst studying for my Pharmacy and Medicine degrees. I will also describe the challenges I faced and the moments of enlightenment I felt when I chose to embark on a career in academia with clinical practice.
