Minimally Invasive Balloon Procedure May Redirect Blood Flow During Cardiac Arrest

Out-of-hospital cardiac arrest has a low survival rate, and patients who do not respond to prolonged advanced resuscitation have few remaining treatment options. During cardiopulmonary resuscitation, blood flow to vital organs is limited, which can prevent the heart from restarting and deprive the brain of oxygen. Despite decades of research, outcomes in this setting have improved only modestly. A new study now shows that resuscitative endovascular balloon occlusion of the aorta may help redirect circulation toward the heart and brain during cardiac arrest.

The feasibility study was conducted by East Anglian Air Ambulance in eastern England between June 2024 and June 2026. It evaluated resuscitative endovascular balloon occlusion of the aorta (REBOA) in adults with out-of-hospital cardiac arrest who had not responded to standard advanced cardiac life support. The findings were presented as preliminary late-breaking science at the American Heart Association’s Resuscitation Science Symposium 2026 in Chicago.

REBOA is a minimally invasive technique in which a small balloon is inserted through an artery in the groin and inflated in the upper aorta. By temporarily blocking blood flow to the lower body during cardiac arrest, the procedure is intended to increase blood pressure and redirect circulation above the balloon, particularly toward the heart and brain.

The study included 39 adults with an average age of 59 years whose cardiac arrests were caused by medical conditions rather than injury. REBOA successfully occluded the upper aorta in 33 of 36 patients in whom the procedure was attempted, and placement took approximately seven minutes from start to finish. The median time from cardiac arrest to balloon inflation was 51 minutes.

Following REBOA, aortic diastolic blood pressure increased by 59%, from 26 to 42 mm Hg, and reached a maximum average increase of 118% at 58 mm Hg. Average systolic blood pressure rose by 20%, from 76 to 91 mm Hg. End-tidal carbon dioxide, a marker of blood flow through the lungs and circulation during resuscitation, increased by 50%. No serious procedure-related adverse effects were reported.

The study did not include a control group and was not designed to determine whether REBOA improves survival or long-term outcomes. Among the 33 patients with confirmed aortic occlusion, eight achieved sustained return of spontaneous circulation and reached the hospital, while two survived to hospital discharge with a good neurological outcome.

“After cardiac arrest, people whose hearts cannot be restarted despite prolonged, high-quality resuscitation efforts, including CPR, breaths, use of an AED, medications and other techniques to restore the heartbeat, currently have very few treatment options and an extremely low chance of survival. Furthermore, survival and treatment options have not meaningfully increased in the last 50 years, so we need to do more in this area,” said James Price, M.B.B.S., lead author of the study, consultant emergency physician at Cambridge University Hospitals NHS Foundation Trust and consultant lead for research and development with the East Anglian Air Ambulance.

“This study is an important first step, but it is not yet proof that REBOA saves lives. A key part of our additional work will be to understand which patients are more likely to benefit from this advanced technique and at what point in their resuscitation care,” Price added.

Related Links
East Anglian Air Ambulance
American Heart Association