Objectives Out‐of‐hospital cardiac arrest (OHCA) claims the lives of approximately 350,000 people in the United States each year. Resuscitative endovascular balloon occlusion of the aorta (REBOA) when used as an adjunct to advanced cardiac life support may improve cardio‐cerebral perfusion. Our primary research objective was to determine the feasibility of emergency department (ED)‐initiated REBOA for OHCA patients in an academic urban ED. Methods This was a single‐center, single‐arm, early feasibility trial that used REBOA as an adjunct to advanced cardiac life support (ACLS) in OHCA. Subjects under 80 years with witnessed OHCA and who received cardiopulmonary rescuitation (CPR) within 6 minutes were eligible. Results Five patients were enrolled between February 2020 and April 2021. The procedure was successful in all patients and 4 of 5 (80%) patients had transient return of spontaneous circulation (ROSC) after aortic occlusion. Unfortunately, all patients re‐arrested soon after intra‐aortic balloon deflation and none survived to hospital admission. At 30 seconds post‐aortic occlusion, investigators noted a statistically significant increase in end tidal carbon dioxide of 26% (95% confidence interval, 10%, 44%). Conclusion Initiating REBOA for OHCA patients in an academic urban ED setting is feasible. Aortic occlusion during chest compressions is temporally associated with improvements in end tidal carbon dioxide 30 seconds after aortic occlusion. Four of 5 patients achieved ROSC after aortic occlusion; however, deflation of the intra‐aortic balloon quickly led to re‐arrest and death in all patients. Future research should focus on the utilization of partial‐REBOA to prevent re‐arrest after ROSC, as well as the optimal way to incorporate this technique with other endovascular reperfusion strategies.

Background Harm reduction services reduce the negative consequences of drug injection and are often embedded within syringe service programs (SSPs). However, people who inject drugs (PWID) suboptimally engage with such services because of stigma, fear, transportation restrictions, and limited hours of operation. Mobile health (mHealth) apps may provide an opportunity to overcome these barriers and extend the reach of SSPs beyond that of the traditional brick-and-mortar models. Objective This study aims to assess the prevalence of smartphone ownership, the level of comfort in providing the personal information required to use mHealth apps, and interest in using an mHealth app to access harm reduction services among PWID to guide the development of an app. Methods We administered a survey to 115 PWID who were enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable in providing personal information such as name, email, and address; and expressed interest in various app-based services. We measured participant characteristics (demographics, health status, and behaviors) and used binary logistic and Poisson regressions to identify independent correlates of mHealth-related variables. The primary regression outcomes included summary scores for access, comfort, and interest. The secondary outcomes included binary survey responses for individual comfort or interest components. Results Most participants were White (74/105, 70.5%), male (78/115, 67.8%), and middle-aged (mean=41.7 years), and 67.9% (74/109) owned a smartphone. Participants reported high levels of comfort in providing personal information to use an mHealth app, including name (96/109, 88.1%), phone number (92/109, 84.4%), email (85/109, 77.9%), physical address (85/109, 77.9%), and linkage to medical records (72/109, 66.1%). Participants also reported strong interest in app-based services, including medication or sterile syringe delivery (100/110, 90.9%), lab or appointment scheduling (90/110, 81.8%), medication reminders (77/110, 70%), educational material (65/110, 59.1%), and group communication forums (64/110, 58.2%). Most participants were comfortable with the idea of home delivery of syringes (93/109, 85.3%). Homeless participants had lower access to smartphones (adjusted odds ratio [AOR] 0.15, 95% CI 0.05-0.46; P=.001), but no other participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfort with the home delivery of syringes (AOR 3.29, 95% CI 1.04-10.3 P=.04), and being older than 50 years was associated with an increased interest in educational materials (AOR 4.64, 95% CI 1.31-16.5; P=.02) and group communication forums (AOR 3.69, 95% CI 1.10-12.4; P=.04). Conclusions Our findings suggest that aside from those experiencing homelessness or unstable housing, PWID broadly have access to smartphones, are comfortable with sharing personal information, and express interest in a wide array of services within an app. Given the suboptimal access to and use of SSPs among PWID, an mHealth app has a high potential to address the harm reduction needs of this vulnerable population.

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BACKGROUND Harm reduction services reduce negative consequences associated with drug injection and are often embedded within syringe service programs (SSPs). People who inject drugs (PWID), however, suboptimally engage with such services due to stigma, fear, transportation restrictions, and limited hours of operation. mHealth applications (apps) may provide an opportunity to overcome these barriers, extending the reach of SSPs beyond the traditional brick-and-mortar models. OBJECTIVE We sought to assess the prevalence of smartphone ownership, level of comfort providing personal information required to use mHealth apps, and interest in the use of a mHealth app to access harm reduction services among PWID in order to guide development of an app. METHODS We administered a survey to 115 PWID enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable providing personal information such as name, email, and address; and expressed interest in a variety of app-based services. Participant demographics, health status and behaviors were also measured to evaluate correlations between participant characteristics and mHealth-related variables. Binary logistic regression and Poisson regression were used to identify independent correlates of mHealth-related variables. Primary regression outcomes included summary scores for access, comfort, and interest. Secondary outcomes included binary survey responses for individual comfort or interest components. RESULTS The majority of this PWID sample were white, male, and middle-aged; and 67.9% owned a smartphone. Participants reported high comfortability with providing personal information in order to use a mHealth app, including name (88.1%), phone number (84.4%), email (78.0%), physical address (78.0%), and linkage to medical records (66.1%). Participants also reported strong interests in app-based services including medications and/or sterile syringes delivery (90.9%), labs or appointments scheduling (81.8%), medication reminders (70.0%), educational material about safe injection practices (59.1%), and group communication forums (58.2%). Most participants were comfortable with the idea of home delivery of syringes (85.0%). Overall, aside from homeless participants having lower access to smartphones (AOR=0.15; P=.001), none of the participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfortability with home delivery of syringes (AOR=3.29, P=0.042), and age >50 years was associated with increased interest in educational materials (AOR=4.64, P=.018) and group communication forums (AOR=3.69, P=.035). CONCLUSIONS Findings here suggest that aside from homelessness, PWID broadly have access to smartphones and they are comfortable sharing a wide array of personal information, including linkage to electronic medical records, and express interest in a wide array of services within an app. Given suboptimal access to and utilization of SSP services among PWID, a mHealth app has high potential to address the harm reduction needs of this vulnerable population.

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