What is the design, eligibility criteria, interventions, and outcomes of the CPReboa trial evaluating Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an adjunct to standard cardiopulmonary resuscitation in adults with refractory non‑traumatic cardiac arrest?

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Last updated: October 2, 2026 • View editorial policy

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CPReboa Trial Overview

The CPReboa trial is a prospective, randomized controlled, single-center study investigating whether Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an adjunct to standard advanced life support improves outcomes in adult patients with in-hospital non-traumatic cardiac arrest 1.

Study Design

The trial employs a parallel-group design with 1:1 randomization comparing:

  • Control arm: Standard advanced life support (ALS) alone
  • Intervention arm: ALS plus REBOA

The planned enrollment is 98 patients over 36 months 1.

Eligibility Criteria

Inclusion Criteria

  • Adult patients (≥18 years)
  • In-hospital cardiac arrest
  • Successful placement of femoral artery introducer sheath
  • Any electrical cardiac activity in the initial rhythm analysis (notably excluding asystole) 1

Exclusion Criteria

  • Traumatic cardiac arrest
  • Asystole as the initial rhythm (critical exclusion)
  • Pregnancy
  • Cardiac arrest occurring in:
    • Intensive care units
    • Operating rooms
    • Cardiac catheterization laboratories 1

Intervention Details

The REBOA technique involves balloon occlusion of the descending (thoracic) aorta, theoretically augmenting:

  • Aortic blood pressure proximal to the balloon
  • Coronary perfusion pressure
  • Cerebral perfusion 1

The physiological rationale is that REBOA may improve perfusion to vital organs without compromising microvascular blood flow, potentially offering advantages over high-dose epinephrine which may adversely affect cerebral microcirculation 1.

Outcomes

Primary Outcome

Sustained return of spontaneous circulation (ROSC) defined as lasting ≥20 minutes 1

Secondary and Exploratory Outcomes

  • Survival rates
  • Neurological outcomes
  • Hemodynamic parameters:
    • Changes in aortic blood pressure
    • End-tidal CO₂ values
    • Near-infrared spectroscopy (NIRS) measurements
  • Causes of death
  • Vascular complications related to the intervention 1

Context Within Current Evidence

This trial addresses a critical gap in resuscitation science. While animal studies and small case series suggest potential benefits of REBOA in cardiac arrest, randomized clinical trials are lacking 1. The CPReboa trial is particularly important given recent conflicting evidence from the prehospital REBOARREST trial, which found that prehospital REBOA in out-of-hospital cardiac arrest did not significantly improve sustained ROSC rates (28% intervention vs 26% control, p=0.78) 2.

Key Distinctions from REBOARREST

  • Setting: In-hospital vs. out-of-hospital
  • Timing: Earlier intervention potential in hospital setting
  • Patient selection: Excludes asystole (worst prognosis rhythm)
  • Logistics: More controlled environment with immediate access to resources

Statistical Approach

Analysis will be performed on a modified intention-to-treat basis, which is appropriate given the procedural nature of the intervention 1.

Clinical Implications

The trial's focus on in-hospital cardiac arrest with electrical activity (excluding asystole) represents a more selective population that may be most likely to benefit from augmented perfusion strategies. The exclusion of ICU, OR, and catheterization lab arrests suggests targeting patients where standard resuscitation infrastructure is immediately available but specialized critical care teams may not be present at arrest onset.

References

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