Abstract 368: A Cardiac Arrest Simulation-Based Feasibility Cadaver Study Investigating Time for Semi Surgical Cut Down Procedure Followed by Insertion of a Novel REBOA Catheter

Abstract

Aim: Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. The Resuscitative endovascular balloon occlusion of the aorta (REBOA) procedure is currently being discussed as a possible technique to be used during Advanced Life Support (ALS) in humans with Cardiac arrest (CA). The aim of this study was to assess the training of emergency physicians in the procedures related to insertion of a novel REBOA catheter. Methods: We developed a training program using a simulated CA model on human cadavers. CPR was performed using the LUCAS device (Stryker/Jolife AB, Lund, Sweden). All cadavers were hemodynamically monitored. The Neurescue REBOA catheter (Neurescue REBOA device, Neurescue ApS, Copenhagen, Denmark) was inserted using a semi-surgical cut-down and sheath placement technique. Time needed to perform the procedures was measured. The procedures were instructed by 2 experts using video, procedural simulation on manikin and full-scale training on cadavers. Results: Six human cadavers were enrolled and a total of 12 procedures were performed by 2 expert investigators and 10 novice investigators. Eight semi-surgical cut-down producers including placements of the introducer sheath were performed on the first attempt and 4 required a second attempt. The median time required for the semi-surgical cutdown procedure and sheath placement by the novice investigators was: 6 min 48 sec (Min: 3 min 45 sec and Max: 26 min 25 sec). The median time required for the insertion and occlusion of the REBOA catheter by the novice investigators was: 3 min 22 sec (Min: 1 min 22 sec and Max: 7 min 5 sec). The median time required for full insertion for the novice investigators was: 11 min 14 sec (Min: 6 min 49 sec and Max: 28 min 15 sec). The mean aortic pressure during compression was: 31.9 mmHg (±17.0). Conclusions: Semi surgical cut-down and introducer sheath placement were performed in 1 or two 2 attempts for all novice investigators with an insertion time compatible with ALS during refractory CA. Simulation training on cadavers brings clinical realism and could be an important addition to the use of manikin or animal training models.