SAAP

Question 1

Describe SAAP

Answer 1

Selective aortic arch reperfusion

A technique that occludes the aorta whilst still perfusing the brain and heart

Question 2

How does SAAP differ from REBOA

Answer 2

SAAP balloon catheter has a large lumen in the centre to allow perfusion and delivery of drugs

Question 3

Where and how is a SAAP catheter placed

Answer 3

Through femoral artery via Seldinger technique and the balloon sits in the descending aorta

Question 4

What are some examples of “perfusion media” used in SAAP

Answer 4

Any oxygen carrying compound:
Whole blood
Haemoglobin based oxygen carriers
Flourocarbon emulsion

Question 5

What is the problem with giving whole blood?

Answer 5

Contains citrate which leads to profound hypocalcaemia that can lead to VF

Question 6

What do we need to give alongside whole blood and why

Answer 6

Bicarb - avoid the refractory VF that occurs when giving whole blood due to the citrate in it causing a hypocalcaemia

Question 7

What do you need to keep in mind when giving drugs intraaortic (SAAP) vs IV

Answer 7

Drug more readily distributed
Drug won’t accumulate in the system as can happen when giving IV drugs in CA
Drug dose may need to be adjusted as blood is perfusing fewer tissues

Question 8

How can the delivery of perfusion media in SAAP lead to pulmonary oedema

Answer 8

In medical patients the delivery of perfusion media needs to be removed from the venous system or else you will get fluid overload and pulmonary oedema

Question 9

When would you consider using SAAP

Answer 9

Haemorrhage induced CA

Patient with REBOA who has a CA

Question 10

What are the limitations of SAAP

Answer 10

only been tested on animals
No studies on long term effects
Practical limitations such as time, training, resources

Question 11

CPR needs to create a pressure gradient large enough to….

Answer 11

Close the aortic valve (or else coronary arteries don’t fill and blood yo-yos between LV and aorta)