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

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 lowoccurrence 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.

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

“…99 Low-cost REBOA trainers have been developed, which could improve access to training resources in the austere setting. 100 Deterioration of skills may be seen with lack of exposure, however, and repeat training may be needed at 6-month intervals. 101 Resuscitative endovascular balloon occlusion of the aorta has been added as a skill included in the new Advanced Surgical Skills for Exposure in Trauma beta course, designed to train military members in essential trauma skills before deployment.…”

“…Even more far forward, efforts have been made to train nonphysicians, including military medical technicians and nurses who may have earlier access to combat casualties and have been successful 99 . Low-cost REBOA trainers have been developed, which could improve access to training resources in the austere setting 100 . Deterioration of skills may be seen with lack of exposure, however, and repeat training may be needed at 6-month intervals 101 .…”

Multidisciplinary Simulation of Trauma in Pregnancy with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Utilization

“…Multiple studies including case reports and larger systematic reviews have demonstrated that the use of REBOA is associated with reduced hemorrhage and reduced blood product transfusions, particularly in the setting of invasive placental disorders such as placenta accreta [1,[3][4][5][6][7]. Multiple simulation studies have been published in both obstetrics and trauma surgery regarding the usage of REBOA in each respective field, and there have also been simulations regarding trauma in pregnancy [8][9][10][11][12][13]. Specifically, no reported simulation-based education for the use of REBOA in traumatically injured pregnant patients was identified in the literature review.…”