Page 39 - JSOM Fall 2021

TABLE 1 Workshop Timetable stages included ultrasound-guided puncture of the femoral
Principles and artery, setting up the guidewire, and placement of the sheath
indications introducer.
Theoretical Vascular access
9.30–11.00
session 1 techniques The primary endpoint was the success rate after training, defin-
Devices and set-up ing success as inflating the balloon in zone 1 of the manneqin.
techniques This was confirmed by opening the chest of the mannequin.
Withdrawal and The secondary endpoints were (1) the progression of each
complications trainee during the training, (2) the difference between the me-
Civilian prehospital dian completion duration before and after training, (3) the
Theoretical point of view median post-training duration, and (4) the median duration
First day 11.15–12.15 session 2 Military prehospital for the placement of the sheath introducer before and after
point of view training. The rationale for this last criterion was that many au-
French military thors agree that the difficulty of REBOA resides in the femoral
guidelines proposal access, and our training was aimed at physicians in the French
Demonstration Armed Forces practicing in the context of tactical helicopter
Handling the devices evacuations. These physicians could have to place arterial ac-
Hands-on
1.30–5.30 session 1 on US-guided vascular cess for patients at high risk of hemodynamic degradation in
model access order to subsequently place a REBOA more quickly.
Balloon set-up and
inflation In parallel with the comparison of the other trainees’ results,
Physiological a self-assessment was performed for each trainee before and
consequences
Theoretical after the training. We used the Likert scale, which is a psycho-
8.00–9.00 Deflation, intermittent 6
session 3 metric tool for measuring behavior. The questions related to
and partial REBOA the trainee’s ease with REBOA indications, knowledge of the
Register data material, and the various technical steps of the procedure. For
Hands-on
Second day session 2 on each of these items, the trainee self-assigned a score of 1 to 5
9.00–12.30 (1: strongly disagree, 2: disagree, 3: neither agree nor disagree,
cadavers and
pigs 4: agree, 5: strongly agree). In addition, each trainee was ob-
Hands-on served by a trainer who ranked different criteria of the ability
session 3 on and fluency, such as care of the tissues, gestures, equipment
2.00–5.30
cadavers and knowledge, procedure knowledge, material handling, fluidity
pigs of the procedure, and use of assistance.
REBOA = resuscitative endovascular balloon occlusion of the aorta,
US = ultrasound.
Statistical Analysis
Univariate associations were evaluated using the student test
After the theoretical half-day and before the half-day dedicated for quantitative data and the Fisher exact test, as appropriate
to teaching using a PryTime mannequin and PryTime balloon (Table 2). All statistical tests were two-tailed with p values
(PryTime Medical, https://prytimemedical.com/) compatible < .05 considered significant.
with a 7-French sheath, a presentation with this material was
organized for all trainees. As a pre-test, each trainee was eval-
uated as he/she installed a REBOA in a mannequin. The other
trainees did not attend the installation of the REBOA, and the Results
examiner did not give any indication or help to the trainee We trained 15 emergency medical physicians; seven were in
being assessed. As a post-test, at the end of the fourth half-day, prehospital emergency departments, four in medical evacua-
each trainee performed the same task under the same condi- tion helicopters, two in strategic medical evacuation aircraft,
tions. The puncture was guided by ultrasound. The material one in Special Forces, and one in a counterterrorism unit.
was in good condition for each new candidate. If the material All agreed to participate in the study and provided signed
was damaged, it was changed immediately. The PryTime man- informed consent. The demographics of this population and
nequin was created to be opened and to assess whether the their respective skills and experience are presented in Table
balloon is in the right position. 3. Thirteen of the 15 participants completed this table. Two
participants did not answer.
The parameters collected were (1) the overall success of the
procedure; (2) the success of certain key stages, such as ul- Primary Endpoint
trasound-guided puncture, set-up of the guidewire, and the A total of 93% (n = 14) of the physicians correctly placed the
placement of the sheath introducer; (3) the overall installation balloon in the mannequin at the end of the training period (Ta-
duration (from the beginning of the procedure until the in- ble 2). One physician failed to perform the ultrasound-guided
flation of the REBOA); and (4) the duration of sheath intro- puncture.
ducer placement. We believe that duration is a very important
point for REBOA use because REBOA is indicated for criti- Secondary Criteria
cally ill patients for whom time to the operating room is the Regarding the progress of the trainees during the internship,
most important factor. The trainee was considered to fail in the success rate increased from 73% (11 successes and four
the procedure if he/she could not accurately place the balloon failures) to 93% (p = .33; Table 2). The median time of in-
in zone 1 or failed to achieve one of the key stages. The key stallation of REBOA after training was only 222 seconds

REBOA Course for Internal Aortic Clamping | 37