A Low-Cost Insertion Trainer for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).

Ryan Walsh,Charles Lei,Ryan J Van Nostrand,Zachary Sletten,Kenneth H Palm

doi:10.7759/cureus.9729

Ryan Walsh, Charles Lei + Show 3 more

Open Access

https://doi.org/10.7759/cureus.9729

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Journal: Cureus	Publication Date: Aug 13, 2020
Citations: 2	License type: cc-by

Affiliation: Vanderbilt University Medical Center

Abstract

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure designed to treat non-compressible torso hemorrhage. Because this is a high-acuity low-occurrence event, it is difficult to train providers on the procedure and difficult for trained providers to stay proficient. Our primary objective was to develop a low-cost, high-fidelity teaching model to increase emergency medicine (EM) resident knowledge, confidence, and proficiency in performing REBOA. We utilized readily available materials to allow for ease of replication and cost-effectiveness. The aorta was simulated by a bicycle tire inner tube, and the femoral artery was simulated by natural rubber tubing. Once connected, these simulated vascular structures were threaded through a plastic torso mold and filled with simulated blood. Participants then performed the REBOA procedure with very little time required for reset between participants. After completing the training using our model, participants completed a survey rating aspects of the session on a five-point Likert scale. Participants included 21 EM residents from all levels of training. Participants rated the fidelity of the REBOA insertion trainer very highly (mean = 4.05, SD 0.67) and felt that the training was overall very useful (mean = 4.29, SD 0.56). Comments regarding the model were universally positive. We present a novel low-cost REBOA task trainer that is easy to build, reusable, and portable, and can be utilized either in a hospital or austere training environment.

Highlights

Non-compressible torso hemorrhage (NCTH) is a life-threatening emergency that carries a mortality rate of 44.6% [1]
A balloon catheter is inserted into the femoral artery and, once inflated, stops otherwise uncontrollable bleeding until the patient can be taken to the operating room or other definitive treatment can be provided
In the United States, resuscitative endovascular balloon occlusion of the aorta (REBOA) is typically performed in trauma centers by trauma surgeons or specially trained emergency physicians [6,7,8]

Summary

Introduction

Non-compressible torso hemorrhage (NCTH) is a life-threatening emergency that carries a mortality rate of 44.6% [1]. The aorta was simulated by a 30-inch length of 25-mm road bicycle tire inner tube and the femoral artery with a 15-inch length of natural rubber tubing with a 3/8-inch outer diameter and 1/4-inch inner diameter These two sections were connected via a 7.5 endotracheal tube (ETT) connector with a hose clamp and sealant to maintain a sealed system at the caudad end of the model (Figure 1). The femoral artery was covered and secured to the torso with selfadherent wrap to simulate skin This allowed for arterial puncture and placement of the introducer sheath as well as ER-REBOA catheter (Figure 5). This maintained the closed system and allowed the model to remain pressurized

Discussion

Conclusions

Disclosures

Greene J