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Learning insertion of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter : Is clinical experience necessary? A prospective trial

Engberg, Morten ; Mikkelsen, Søren ; Hörer, Tal ; Lindgren, Hans LU ; Søvik, Edmund ; Frendø, Martin ; Svendsen, Morten Bo ; Lönn, Lars ; Konge, Lars and Russell, Lene , et al. (2023) In Injury 54(5). p.1321-1329
Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging and potentially life-saving procedure, necessitating qualified operators in an increasing number of centres. The procedure shares technical elements with other vascular access procedures using the Seldinger technique, which is mastered by doctors not only in endovascular specialties but also in trauma surgery, emergency medicine, and anaesthesiology. We hypothesised that doctors mastering the Seldinger technique (experienced anaesthesiologist) would learn the technical aspects of REBOA with limited training and remain technically superior to doctors unfamiliar with the Seldinger technique (novice residents) given similar training. Methods: This... (More)

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging and potentially life-saving procedure, necessitating qualified operators in an increasing number of centres. The procedure shares technical elements with other vascular access procedures using the Seldinger technique, which is mastered by doctors not only in endovascular specialties but also in trauma surgery, emergency medicine, and anaesthesiology. We hypothesised that doctors mastering the Seldinger technique (experienced anaesthesiologist) would learn the technical aspects of REBOA with limited training and remain technically superior to doctors unfamiliar with the Seldinger technique (novice residents) given similar training. Methods: This was a prospective trial of an educational intervention. Three groups of doctors were enroled: novice residents, experienced anaesthesiologists, and endovascular experts. The novices and the anaesthesiologists completed 2.5 h of simulation-based REBOA training. Their skills were tested before and 8–12 weeks after training using a standardised simulated scenario. The endovascular experts, constituting a reference group, were equivalently tested. All performances were video recorded and rated by three blinded experts using a validated assessment tool for REBOA (REBOA-RATE). Performances were compared between groups and with a previously published pass/fail cutoff. Results: Sixteen novices, 13 board-certified specialists in anaesthesiology, and 13 endovascular experts participated. Before training, the anaesthesiologists outperformed the novices by 30 percentage points of the maximum REBOA-RATE score (56% (SD 14.0) vs 26% (SD 17%), p<0.01). After training, there was no difference in skills between the two groups (78% (SD 11%) vs 78 (SD 14%), p = 0.93). Neither group reached the endovascular experts' skill level (89% (SD 7%), p<0.05). Conclusion: For doctors mastering the Seldinger technique, there was an initial inter-procedural transfer of skills advantage when performing REBOA. However, after identical simulation-based training, novices performed equally well to anaesthesiologists, indicating that vascular access experience is not a prerequisite to learning the technical aspects of REBOA. Both groups would need more training to reach technical proficiency.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Clinical Competence, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), Simulation, Skills, Validity evidence, Vascular access, Assessment tool
in
Injury
volume
54
issue
5
pages
1321 - 1329
publisher
Elsevier
external identifiers
  • scopus:85149891137
ISSN
0020-1383
DOI
10.1016/j.injury.2023.02.048
language
English
LU publication?
yes
id
4d6e3028-1c25-45b5-881e-16dba6efd9f9
date added to LUP
2023-04-06 12:43:50
date last changed
2023-10-26 14:48:53
@article{4d6e3028-1c25-45b5-881e-16dba6efd9f9,
  abstract     = {{<p>Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging and potentially life-saving procedure, necessitating qualified operators in an increasing number of centres. The procedure shares technical elements with other vascular access procedures using the Seldinger technique, which is mastered by doctors not only in endovascular specialties but also in trauma surgery, emergency medicine, and anaesthesiology. We hypothesised that doctors mastering the Seldinger technique (experienced anaesthesiologist) would learn the technical aspects of REBOA with limited training and remain technically superior to doctors unfamiliar with the Seldinger technique (novice residents) given similar training. Methods: This was a prospective trial of an educational intervention. Three groups of doctors were enroled: novice residents, experienced anaesthesiologists, and endovascular experts. The novices and the anaesthesiologists completed 2.5 h of simulation-based REBOA training. Their skills were tested before and 8–12 weeks after training using a standardised simulated scenario. The endovascular experts, constituting a reference group, were equivalently tested. All performances were video recorded and rated by three blinded experts using a validated assessment tool for REBOA (REBOA-RATE). Performances were compared between groups and with a previously published pass/fail cutoff. Results: Sixteen novices, 13 board-certified specialists in anaesthesiology, and 13 endovascular experts participated. Before training, the anaesthesiologists outperformed the novices by 30 percentage points of the maximum REBOA-RATE score (56% (SD 14.0) vs 26% (SD 17%), p&lt;0.01). After training, there was no difference in skills between the two groups (78% (SD 11%) vs 78 (SD 14%), p = 0.93). Neither group reached the endovascular experts' skill level (89% (SD 7%), p&lt;0.05). Conclusion: For doctors mastering the Seldinger technique, there was an initial inter-procedural transfer of skills advantage when performing REBOA. However, after identical simulation-based training, novices performed equally well to anaesthesiologists, indicating that vascular access experience is not a prerequisite to learning the technical aspects of REBOA. Both groups would need more training to reach technical proficiency.</p>}},
  author       = {{Engberg, Morten and Mikkelsen, Søren and Hörer, Tal and Lindgren, Hans and Søvik, Edmund and Frendø, Martin and Svendsen, Morten Bo and Lönn, Lars and Konge, Lars and Russell, Lene and Taudorf, Mikkel}},
  issn         = {{0020-1383}},
  keywords     = {{Clinical Competence; Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA); Simulation; Skills; Validity evidence; Vascular access, Assessment tool}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1321--1329}},
  publisher    = {{Elsevier}},
  series       = {{Injury}},
  title        = {{Learning insertion of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter : Is clinical experience necessary? A prospective trial}},
  url          = {{http://dx.doi.org/10.1016/j.injury.2023.02.048}},
  doi          = {{10.1016/j.injury.2023.02.048}},
  volume       = {{54}},
  year         = {{2023}},
}