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

Animals Balloon Occlusion / methods Endovascular Procedures / education Feasibility Studies Humans Models, Cardiovascular Swine
balloon occlusion of aorta training vascular access

Journal

Journal of the Royal Army Medical Corps
ISSN: 2052-0468
Titre abrégé: J R Army Med Corps
Pays: England
ID NLM: 7505627

Informations de publication

Date de publication:
Jun 2019
Historique:
received: 13 05 2018
revised: 08 07 2018
accepted: 10 07 2018
pubmed: 20 9 2018
medline: 19 12 2019
entrez: 20 9 2018
Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1136/jramc-2018-000972 PMID: 30228195
pubmed: 30228195
pii: jramc-2018-000972
doi: 10.1136/jramc-2018-000972
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

147-151

Informations de copyright

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: None declared.

Auteurs

Boudewijn L S Borger van der Burg (BLS)

Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands blsborgervanderburg@alrijne.nl.
ORCID: 0000-0002-1199-4042

T M Hörer (TM)

Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science, Örebro University Hospital, Örebro, Sweden.

D Eefting (D)

Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands.
Leiden University Medical Centre, Leiden, The Netherlands.

T T C F van Dongen (TTCF)

Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.

J F Hamming (JF)

Leiden University Medical Centre, Leiden, The Netherlands.

J J DuBose (JJ)

R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA.

M Bowyer (M)

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

R Hoencamp (R)

Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
Leiden University Medical Centre, Leiden, The Netherlands.
Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Vascular access training for REBOA placement:...
questionsmedicales.fr › Techniques d'investigation › Cathétérisme › Occlusion par ballonnet › Vascular access training for REBOA placement:...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Vascular access training for REBOA placement:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études de faisabilité › Vascular access training for REBOA placement:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Vascular access training for REBOA placement:...
questionsmedicales.fr › Techniques d'investigation › Modèles théoriques › Modèles biologiques › Modèles cardiovasculaires › Vascular access training for REBOA placement:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Artiodactyla › Suidae › Vascular access training for REBOA placement:...