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

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.