Vascular access training for REBOA placement: A feasibility study in a live tissue-simulator hybrid porcine model

Boudewijn L.S.Borger Van Der Burg*, T. M. Hörer, D. Eefting, T. T.C.F. Van Dongen, J. F. Hamming, J. J. Dubose, M. Bowyer, R. Hoencamp

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with severe haemorrhagic shock is increasing. Obtaining vascular access is a necessary prerequisite for REBOA placement in these situations. Methods During the EVTM workshop (September 2017, Örebro, Sweden), 21 individuals participated in this study, 16 participants and five instructors. A formalised curriculum was constructed including basic anatomy of the femoral region and basic training in access materials for REBOA placement in zone 1. Key skills: (1) preparation of endovascular toolkit, (2) achieving vascular access in the model and (3) bleeding control with REBOA. Scoring ranged from 0 to 5 for non-anatomical skills. Identification of anatomical structures was either sufficient (score=1) or insufficient (score=0). Five consultants performed a second identical procedure as a post test. Results Consultants had significantly better overall technical skills in comparison with residents (p=0.005), while understanding of surgical anatomy showed no difference. Procedure times differed significantly (p<0.01), with residents having a median procedure time of 3 min and 24 s, consultants 2:33 and instructors 1:09. Conclusion This comprehensive training model using a live tissue-simulator hybrid porcine model can be used for femoral access and REBOA placement training in medical personnel with different prior training levels. Higher levels of training are associated with faster procedure times. Further research in open and percutaneous access training is necessary to simulate real-life situations. This training method can be used in a multistep training programme, in combination with realistic moulage and perfused cadaver models.

Original languageEnglish
Pages (from-to)147-151
Number of pages5
JournalJournal of the Royal Army Medical Corps
Volume165
Issue number3
DOIs
StatePublished - 1 Jun 2019
Externally publishedYes

Keywords

  • balloon occlusion of aorta
  • training
  • vascular access

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