Page 38 - JSOM Fall 2021

Effectiveness of Short Training in Resuscitative Endovascular Balloon

Occlusion of the Aorta (REBOA) by Emergency Physicians
The Applied Course for Internal Aortic Clamping on Field Mission

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Oscar Thabouillot, MD *; Guillaume Boddaert, MD ; Stéphane Travers, MD ;
Christophe Dubecq, MD ; Clément Derkenne, MD ; Romain Kedzierewicz, MD ;
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Kilian Bertho, MD ; Bertrand Prunet, MD 8
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ABSTRACT
Background: Resuscitative endovascular balloon occlusion of only be maintained by the surgeon or the physician perform-
the aorta (REBOA) is a technique that uses internal clamping of ing the radioembolization. When the bleeding is too severe,
the aorta to control abdominal, pelvic, or junctional bleeding. the patient does not arrive alive at the hospital, despite the
We created a course to train military physicians in both civilian resuscitation efforts of the medical team.
prehospital use and battlefield use. To determine the effective-
ness of this training, we conducted REBOA training for French The French system is based on sending a medical team to any
military emergency physicians. Methods: We trained 15 mili- vital distress call. In recent years, REBOA has been used by
tary physicians, organizing the training as follows: a half-day some departments, particularly those with teams composed of
of theoretical training, a half-day of training on mannequins, surgeons. However, the French physicians in medical teams
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a half-day on human corpses, and a half-day on a living pig. are emergency doctors and do not practice surgery, but they
The primary endpoint was the success rate after training. We are familiar with central vascular access.
defined success as the balloon being inflated in zone 1 of a Pry-
Time mannequin. The secondary endpoints were the progres- Interest in the technique was reinforced by a descriptive retro-

sion of each trainee during the training, the difference between spective study performed by our team, showing that nearly 3%
the median completion duration before and after training, the of patients (37 patients per year or one patient every 9 days)
median post-training duration, and the median duration for the rescued by our department could potentially benefit from a
placement of the sheath introducer before and after training. REBOA. We created a course to train military physicians for
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Results: Fourteen of the physicians (93%) correctly placed the both civilian prehospital use and battlefield use of REBOA
balloon in the mannequin at the end of the training period. with the objective of successfully training the majority of phy-
During the training, the success rate increased from 73% to sicians in the technique. We determined the effectiveness of the
93% (p = .33). The median time for REBOA after training was REBOA training by conducting the training for French mili-
only 222 seconds (interquartile range [IQR] 194–278), sig- tary emergency physicians. Our hypothesis was that our short
nificantly faster than before training (330 seconds, IQR 260– training is effective in achieving successful use of REBOA.
360.5; p = .0033). We also found significantly faster sheath
introducer placement (148 seconds, IQR 126–203 versus145
seconds, IQR 115.5–192.5; p = .426). Conclusion: The training Methods
can be performed successfully and paves the way for the use of The training was composed of 4 half-days and was super-
REBOA by emergency physicians in austere conditions. vised by three emergency physicians and one vascular surgeon
skilled in the placement of REBOA. This training was orga-
Keywords: accident and emergency medicine; education and nized as follows: a half-day of theoretical training, a half-day
training; trauma managmennt; REBOA; military of training on mannequins (more details below), a half-day on
human corpses, and a half-day on a living pig (Table 1). The
following learning objectives were defined by the trainers up-
stream of the training session: (1) the principle and indications
Introduction
of internal aortic clamping and its physiological consequences;
Resuscitative endovascular balloon occlusion of the aorta (2) to learn and perform the different techniques using arterial
( REBOA) is a technique that uses internal clamping of the access; and (3) to learn and perform the balloon placement
aorta to control abdominal, pelvic, or junctional (APJ) bleed- on a mannequin, a cadaver, and a living pig. Fifteen military
ing. This technique is of interest to emergency physicians, personnel were trained. None of them had received previous
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especially those working in prehospital care. Unlike bleeding REBOA training. Each trainee had to complete a pre-test de-
in extremities, APJ bleeding is not easily controlled, if at all, scribing his/her experience in emergency medicine, particu-
during prehospital care with a tourniquet. Hemostasis can larly their ease with femoral arterial access.
*Correspondence to thabouillot@hotmail.com
1 CPT Oscar Thabouillot is affiliated with the 10th Medical Center, French Military Health Service, France. COL Guillaume Boddaert is affili-
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ated with the Thoracic and Vascular Surgery Department, Percy Military Teaching Hospital, Paris, France. COL Stéphane Travers is affiliated
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with the Val-de-Grace School of the French Military Health Service, Paris, France. MAJ Christophe Dubecq is affiliated with the French Military
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Health Service. COL Clément Derkenne, COL Romain Kedzierewicz, COL Kilian Bertho, and COL Bertrand Prunet are affiliated with the
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Emergency Department of the Paris Fire Brigade, France.
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