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Resuscitative endovascular balloon occlusion of the aorta: simulation improves performance but may require interval training to prevent skill degradation

Abstract

Purpose

Surgical trainees are exposed to less procedures with increasing need for simulation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become increasingly implemented for hemorrhage control, yet most courses are catered to faculty level with little data on trainees. We propose that routine training in this critical procedure will improve trainee performance over time.

Methods

This is a prospective, observational study at a level I trauma center involving a monthly trauma procedural program. Early in the month, trainees received hands-on REBOA training; at the end, trainees underwent standardized, class-based evaluation on a perfused trainer. Score percentages were recorded (0–100%). Endpoints included early, mid and late performance (2–12 months). Paired T-test and Pearson’s coefficient were used to evaluate differences and strength of association between time between training and performance.

Results

25 trainees participated with 5 and 11 repeat learners in the PGY-2 and PGY-3 classes, respectively. Median early performance score was 62.5% (IQR 56–81) for PGY-2s and 91.6% (IQR 75–100) in PGY-3s. Pearson’s coefficient between time between and training and score demonstrated a weak correlation in the PGY-2s (r2 = − 0.13), but was more pronounced in the PGY-3s (r2 = − 0.44) with an inflection point at 5 months.

Conclusions

Routine REBOA training in trainees is associated with improvement in performance within a short period of time. Skill degradation was most pronounced in trainees who did not receive training for more than 5 months. Trainees can be successfully trained in REBOA; however, this should be done at shorter intervals to prevent skill degradation.

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Code availability

Excel for basic statistics, otherwise not applicable.

References

  1. Joseph B, Zeeshan M, Sakran JV, Hamidi M, Kulvatunyou N, et al. Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in civilian trauma. JAMA Surg. 2019;154:500–8.

    Article  Google Scholar 

  2. Anderson KL, Morgan JD, Castaneda MG, Boudreau SM, Araña AA, et al. The effect of chest compression location and occlusion of the aorta in a traumatic arrest model. J Surg Res. 2020;254:64–74.

    Article  Google Scholar 

  3. van der Borger Burg BLS, van Dongen TTCF, Morrison JJ, HedemanJoosten PPA, DuBose JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. Eur J Trauma Emerg Surg. 2018;44:535–50.

    Article  Google Scholar 

  4. Brenner M, Hoehn M, Pasley J, Dubose J, Stein D, et al. Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg. 2014;77:286–91.

    Article  Google Scholar 

  5. Hatchimonji JS, Sikoutris J, Smith BP, Vella MA, Dumas RP, et al. The REBOA dissipation curve: training starts to wane at 6 months in the absence of clinical REBOA cases. J Surg Educ. 2020. https://doi.org/10.1016/j.jsurg.2020.05.003.

    Article  PubMed  Google Scholar 

  6. Engberg M, Taudorf M, Rasmussen NK, Russell L, Lönn L, et al. Training and assessment of competence in resuscitative endovascular balloon occlusion of the aorta (REBOA)—a systematic review. Injury. 2020;51:147–56.

    Article  Google Scholar 

  7. van der Borger Burg BLS, Hörer TM, Eefting D, van Dongen TTCF, Hamming JF, et al. Vascular access training for REBOA placement: a feasibility study in a live tissue-simulator hybrid porcine model. J R Army Med Corps. 2019;165:147–51.

    Article  Google Scholar 

  8. Brede JR, Lafrenz T, Krüger AJ, Søvik E, Steffensen T, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme. BMJ Open. 2019;9:e027980.

    Article  Google Scholar 

  9. Neequaye SK, Aggarwal R, Van Herzeele I, Darzi A. Cheshire NJ Endovascular skills training and assessment. J Vasc Surg. 2007;46:1055–64.

    Article  Google Scholar 

  10. Villamaria CY, Eliason JL, Napolitano LM, Stansfield RB, Spencer JR, et al. Endovascular Skills for Trauma and Resuscitative Surgery (ESTARS) course: curriculum development, content validation, and program assessment. J Trauma Acute Care Surg. 2014;76:929–35.

    Article  Google Scholar 

  11. Grabo D, Polk T, Minneti M, Inaba K. Demetriades D Brief report on combat trauma surgical training using a perfused cadaver model. J Trauma Acute Care Surg. 2020;89:S175–9.

    Article  Google Scholar 

  12. Burkard DJ, Thompson J, Dull M, Haverkamp J, Koestner A, et al. Resuscitative endovascular balloon occlusion of the aorta process improvement: examining a novel case evaluation tool and standardized simulations. J Trauma Nurs. 2020;27:82–7.

    Article  Google Scholar 

  13. Darrabie MD, Croft CA, Brakenridge SC, Mohr AM, Rosenthal MA, et al. Resuscitative endovascular balloon occlusion of the aorta: implementation and preliminary results at an academic level I trauma center. J Am Coll Surg. 2018;227:127–33.

    Article  Google Scholar 

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Funding

Non-funded.

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Authors and Affiliations

Authors

Contributions

CP, JG, PG, RD, SB, GB, KK, KA and MC assisted with concept, curriculum development and training. CP, JG, PG, and RD contributed to data review, statistical analysis and manuscript development.

Corresponding author

Correspondence to Caroline Park.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All human studies were approved by an institutional research council and were performed in accordance with ethical standards.

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Park, C., Grant, J., Garigipati, P. et al. Resuscitative endovascular balloon occlusion of the aorta: simulation improves performance but may require interval training to prevent skill degradation. Eur J Trauma Emerg Surg 48, 1955–1959 (2022). https://doi.org/10.1007/s00068-021-01815-9

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  • DOI: https://doi.org/10.1007/s00068-021-01815-9

Keywords

  • Resuscitative endovascular balloon occlusion of the aorta
  • Simulation
  • Surgical training