Vascular access training for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement: A feasibility study in emergency physicians

Background: Training vascular access skills for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to emergency physicians (EPs) could contribute to better outcomes in patients with non-compressible truncal hemorrhage. This study aimed to determine whether a concise training program could train EPs to recognize anatomical structures and correctly visualize and identify the puncture site for percutaneous REBOA catheter placement. Methods: Our training program included basic anatomy and training in access materials for REBOA. Participants underwent expert-guided practice on each other and were then tested on key skills: the identification of anatomical structures, anatomy knowledge, technical skills for vascular access imaging with a handheld ultrasound, and time to identify adequate puncture site of the common femoral artery (CFA). Consultant vascular surgeons functioned as expert controls. Results: Eleven EPs participated. They had a median overall technical skills score of 32.5 (27.0-35.0) and median time to identify the CFA puncture site of 52.9 s (35.6-63.7), which improved to 34.0 s (21.2-44.7) at the post-test (Z = -2.756, P = 0.006). Consultant vascular surgeons were significantly faster (P = 0.000). Conclusions: EPs are capable of visualizing the femoral artery and vein within 1 min. This speed improved rapidly after repetition. Our concise training program proved useful regardless of prior endovascular experience. This program, as a component of an expanded Endovascular Resuscitation and Trauma Management curriculum, in combination with realistic task training models (simulator, perfused cadaver, or live tissue) has the potential to provide effective training of the skills required to competently perform REBOA.