DOI QR코드

DOI QR Code

Analysis of procedural performance after a pilot course on endovascular training for resuscitative endovascular balloon occlusion of the aorta

  • Sung Wook Chang (Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital) ;
  • Dong Hun Kim (Department of Surgery, Trauma Center, Dankook University Hospital) ;
  • Dae Sung Ma (Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital) ;
  • Ye Rim Chang (Department of Surgery, Trauma Center, Dankook University Hospital)
  • 투고 : 2022.04.30
  • 심사 : 2022.08.16
  • 발행 : 2023.03.31

초록

Purpose: As resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed in an extremely emergent situation, achieving competent clinical practice is mandatory. Although there are several educational courses that teach the REBOA procedure, there have been no reports evaluating the impact of training on clinical practice. Therefore, this study is aimed to evaluate the effects of the course on procedural performance during resuscitation and on clinical outcomes. Methods: Patients who were managed at a regional trauma center in Dankook University Hospital from August 2016 to February 2018 were included and were grouped as precourse (August 2016-August 2017, n=9) and postcourse (September 2017- February 2018, n=9). Variables regarding injury, parameters regarding REBOA procedure, morbidity, and mortality were prospectively collected and reviewed for comparison between the groups. Results: Demographics and REBOA variables did not differ between groups. The time required from arterial puncture to balloon inflation was significantly shortened from 9.0 to 5.0 minutes (P=0.003). There were no complications associated with REBOA after the course. Mortality did not show any statistical difference before and after the course. Conclusions: The endovascular training for REBOA pilot course, which uses a modified form of flipped learning, realistic simulation of ultrasound-guided catheter insertion and balloon manipulation, and competence assessment, significantly improved procedural performance during resuscitation of trauma patients.

키워드

참고문헌

  1. Chang YR, Park CY, Kim DH, Ma DS, Chang SW. A course on endovascular training for resuscitative endovascular balloon occlusion of the aorta: a pilot study for residents and specialists. Ann Surg Treat Res 2020;99:362-9. https://doi.org/10.4174/astr.2020.99.6.362
  2. Kim S, Chung JS, Jang SW, Jung PY. Pitfalls, complications, and necessity of education about REBOA: a single regional trauma center study. J Trauma Inj 2020;33:153-61. https://doi.org/10.20408/jti.2020.0049
  3. Engberg M, Taudorf M, Rasmussen NK, Russell L, Lonn L, Konge L. Training and assessment of competence in resuscitative endovascular balloon occlusion of the aorta (REBOA): a systematic review. Injury 2020;51:147-56. https://doi.org/10.1016/j.injury.2019.11.036
  4. Chang SW, Ma DS, Chang YR, Kim DH. Practical tips for performing resuscitative endovascular balloon occlusion of the aorta. Hong Kong J Emerg Med 2021;28:165-73. https://doi.org/10.1177/1024907921994422
  5. Bulger EM, Perina DG, Qasim Z, et al. Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA, 2019: a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians. Trauma Surg Acute Care Open 2019;4:e000376.
  6. Hoyer R, Means R, Robertson J, et al. Ultrasound-guided procedures in medical education: a fresh look at cadavers. Intern Emerg Med 2016;11:431-6. https://doi.org/10.1007/s11739-015-1292-7
  7. Gurm HS, Sanz-Guerrero J, Johnson DD, et al. Using simulation for teaching femoral arterial access: a multicentric collaboration. Catheter Cardiovasc Interv 2016;87:376-80. https://doi.org/10.1002/ccd.26256
  8. Engberg M, Taudorf M, Russell L, Konge L, Lonn L. Comments on "A course on endovascular training for resuscitative endovascular balloon occlusion of the aorta: a pilot study for residents and specialists". Ann Surg Treat Res 2021;101:129-30. https://doi.org/10.4174/astr.2021.101.2.129
  9. Engberg M, Horer T, Rasmussen TE, et al. Developing a tool to assess competence in resuscitative endovascular balloon occlusion of the aorta: an international Delphi consensus study. J Trauma Acute Care Surg 2021;91:310-7. https://doi.org/10.1097/TA.0000000000003191
  10. Engberg M, Lonn L, Konge L, et al. Reliable and valid assessment of procedural skills in resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg 2021;91:663-71. https://doi.org/10.1097/TA.0000000000003338
  11. Hatchimonji JS, Sikoutris J, Smith BP, et al. The REBOA dissipation curve: training starts to wane at 6 months in the absence of clinical REBOA cases. J Surg Educ 2020;77:1598-604. https://doi.org/10.1016/j.jsurg.2020.05.003