Page 41 - Journal of Special Operations Medicine - Spring 2017

Figure 1 Graphic representation of zones 1 and 3. Figure 3 Procedure time per trial by group.

Based on Stannard et al, J Trauma. 2011;71:1869–1872.
https://www.ncbi.nlm.nih.gov/pubmed/22182896
Evaluations
The examiner evaluated each participant on the simu-
Figure 2 Evaluated steps of REBOA task performance. lated performance of REBOA. The examiner subjectively
evaluated performance on a scale of 1 to 5 (Likert scale)
1 Access of the common femoral artery. Verbalizes use for the following tasks: microcatheter exchange, guide-
of femoral arterial line kit, external landmarks,
optional use of ultrasound, importance of needle wire manipulation, balloon manipulation, balloon infla-
entry and cannulation. tion, and balloon and guidewire removal.
2 Insert Amplatz Guidewire into the arterial line catheter
to proximal Zone 1 using external landmarks (below A score of 5 would be awarded for demonstration of
2nd rib space). consistent and proper handling of wires and balloon,
3 Upsize a-line catheter to 12 Fr sheath. Verbalizes economy of motion, sound knowledge of the indica-
knowledge of 8 and 10Fr dilators for gentle upsizing, tions for REBOA, and completion within the required
and when those may be required. time limit. Criteria for a score of 1 included inability to
4 Advance sheath to the proximal common iliac artery identify indications for REBOA, choosing tools incor-
(external landmark: below the umbilicus). Verbalized rectly, overinflating the balloon, inability to perform the
need for dilator to be used in every case of sheath procedure within 5 minutes, and performing the skills
advancement, whether initial or in the event that out of sequence. The numeric evaluation was based on
the sheath retracts slightly during manipulation
of balloon. novice performers; thus, a score of 5 corresponded to an
5 Advance balloon to distal Zone 1 (external landmark: excellent performance for a novice or beginner.
xiphoid) and inflate to moderate resistance. Data Analysis
6 Verbalizes need to observe changes in hemodynamics Summary descriptive statistics for normally distributed
while continuing resuscitation and diagnosis /
treatment of hemorrhagic source as indicated. variables are reported as mean ± standard deviation or
7 Once need for occlusion has passed, removal of the median (interquartile range), as appropriate. The un-
paired Student t test was used to analyze continuous
balloon. Verbalizes cutting down on the common
femoral artery and obtaining proximal and distal data and the Fisher exact test was used to compare cat-
control, removal of sheath, wire, and repair artery egorical data. Statistical significance was set at .05 and
as indicated. all tests were two-tailed.
Fr, French.
Results
placement was required, a static fluoroscopic image was
shown as a surrogate for a portable radiograph. After Within our study group, there was a significant decrease
the skills performance, a posttest was administered and in the procedural times moving from trial 1 to trial 6.
comparisons made to the pretest. Overall time for REBOA completion decreased from

Balloon Occlusion of the Aorta 19