Endovascular resuscitation: an expert practice review

Abstract

Endovascular resuscitation (EVR) describes a collection of novel therapies that aim to bridge patients in shock states or cardiac arrest to definitive treatment, through a combination of haemorrhage control and mechanical circulatory support. The last half-decade has seen landmark trials report on several techniques and adoption is growing despite controversies around risk, efficacy and implementation. As leaders in resuscitation, it is essential that emergency physicians understand the principles and practice of endovascular techniques to advocate for the critically unwell patients that may benefit from EVR and be engaged in future implementation.This practice review aims to provide emergency physicians with an overview of EVR, based around case scenarios of out-of-hospital cardiac arrest and non-compressible haemorrhage. We review the rationale for EVR in these conditions and describe the critical initial step of vascular access. We then describe the physiology, technique, efficacy and safety of three escalating interventions: resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion and extracorporeal cardiopulmonary resuscitation.