Vascular Access Training for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Placement: A Feasibility Study in Emergency Physicians

Authors

  • Suzanne M Vrancken, MD Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands https://orcid.org/0000-0002-4553-794X
  • Rayner C.L.A. Maayen, MD Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
  • Boudewijn L.S. Borger van der Burg, MD Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
  • Daniël Eefting, MD PhD Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands
  • Thijs T.C.F. van Dongen, MD PhD Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
  • Ingvar T.B. Berg, MD Emergency Department, Haaglanden Medical Centre, The Hague, the Netherlands
  • Mark W. Bowyer, MD Department of Surgery, Uniformed Services University of Health Sciences, and the Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  • Rigo Hoencamp, MD PhD Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

DOI:

https://doi.org/10.26676/jevtm.v5i1.193

Keywords:

vascular access, ultrasound, training, aortic balloon occlusion, emergency physicians, REBOA

Abstract

Background

Vascular access is a prerequisite for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) placement. Training such skills to emergency physicians (EPs) could contribute to better outcomes in non-compressible truncal hemorrhage patients. 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 placement of a REBOA catheter.

Methods

Eleven EPs participated in our training program, including basic anatomy and training in access materials for REBOA. Participants underwent expert-guided practice on each other and were then tested on key skills to include: identification of anatomical structures, anatomical knowledge, technical skills for vascular access imaging with a handheld ultrasound, and time to identify adequate puncture site of the Common Femoral Artery (CFA) with ultrasound. Consultant vascular surgeons functioned as expert controls.

Results

EPs had a median overall technical skills score of 32.5 [27.0-35.0]. All EPs were able to identify the correct CFA puncture site with a median time of 52.9 seconds [35.6-63.7] at the first attempt and 34.0 seconds [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 one minute. The speed of correct visualisation improved rapidly after repetition. Our concise theoretical and practical training program proved useful regardless of prior endovascular experience and training. 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.

Author Biographies

Suzanne M Vrancken, MD, Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

Affiliations:

1. Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

2. Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

Rayner C.L.A. Maayen, MD, Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

Affiliations:

1. Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

Boudewijn L.S. Borger van der Burg, MD, Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

Affiliations:

1. Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

Daniël Eefting, MD PhD, Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands

Affiliations:

3. Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands

4. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

Thijs T.C.F. van Dongen, MD PhD, Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

Affiliations:

1. Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

5. Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands

Ingvar T.B. Berg, MD, Emergency Department, Haaglanden Medical Centre, The Hague, the Netherlands

Affiliations:

6. Emergency Department, Haaglanden Medical Centre, The Hague, the Netherlands

Mark W. Bowyer, MD, Department of Surgery, Uniformed Services University of Health Sciences, and the Walter Reed National Military Medical Center, Bethesda, Maryland, USA

Affiliations:

7. Department of Surgery, Uniformed Services University of Health Sciences, and the Walter Reed National Military Medical Center, Bethesda, Maryland, USA

Rigo Hoencamp, MD PhD, Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

Affiliations:

1. Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

2. Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

4. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

5. Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands

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Published

2021-06-04

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Section

Original Article