Page 36 - JSOM Fall 2025

TABLE 2 Demographics of Participants surgical team. This location was staffed by a German surgical
Provider type No. of participants team. At the time of this project, this team reported not us-
Physician 32 ing or supporting use of the REBOA device in Germany, and
therefore not having formal training on it prior to deployment.
Medic 54
Physician assistant 4 Support Staff (Medics and Nurses)
Nurse practitioner 2 Out of the 81 medic and nurse participants, one had experience
Certified registered nurse anesthetist 2 and proficiency in ER-REBOA indications and post—balloon
Nurse 19 deployment monitoring. This corresponds to one individual
(nurse) who had received training at a civilian institution (part
Equipment Requirement of a REBOA training study). Additionally, most of the support
While all four sites had ER-REBOA devices and introducer staff had never set up an arterial line prior to the subsequent
catheter kits, none of the sites had a complete complement of training event. Only 17 out of 81 (20.7%) felt comfortable set-
manufacturer-recommended equipment (Table 3). One facility ting up the arterial pressure line system to monitor the balloon.
only had expired introducer kits, as aforementioned. One fa- Nursing staff also reported predeployment unit-based training
cility (Role 2/FRST) did not have the compatible arterial line did not include arterial line management. Of nurses surveyed,
tubing and transducer cables to monitor arterial pressures. critical care nurses who initially trained in the intensive care unit
None of the sites maintained a supply of disposable vascular were not comfortable with arterial line set-up or management.
pressure devices as the Centurion Compass devices (Medline,
Northfield, IL) or femoral arterial line kits.
Discussion
All four locations were inside a hardened military structure While none of the sites had the complete complement of
converted to an MTF. Each site had a resuscitation bay or manufacturer-recommended equipment, they had the basic,
an operating theater where an endovascular balloon can be necessary equipment of the ER-REBOA and introducer cathe-
placed in a sterile or semi-sterile environment. ters. Three of the four sites were capable of deploying an ER-
REBOA catheter with the incapable site having trained staff but
REBOA-Capable Provider nonfunctional equipment (i.e., expired ER-REBOA catheter and
Each location had a physician who had completed the BEST introducer kits). Arterial pressure monitoring was not available
course. This was the emergency medicine physician at one lo- at a location because of incompatible cables. While invasive ar-
cation and general surgeons at the other three. One Regional terial monitoring in placement of REBOA is helpful, it is not an
Role 3 had two providers found by consensus agreement of absolute necessity. The purpose for arterial monitoring is to 1)
the investigators to have familiarization training. One of the help confirm ER-REBOA balloon deployment and 2) measure
locations had this provider incidentally present as a medical blood pressure proximal to balloon occlusion. These goals can
asset at the location, but they were not formally part of the be achieved with other means, as with a Compass device and/or

TABLE 3 Results of Site Survey, Focus Group Discussion, and Survey
Site #1 Site #2 Site #3 Site #4
Survey item (Regional Role 3) (Regional Role 3) (Regional FRST/Role 2) (Regional FRST/Role 2)
Minimum equipment required
(catheter and introducer) Yes Yes Yes Yes
Manufacturer-recommended equipment
(all items below) No No No No
ER-REBOA catheter (no. available) Yes (11) Yes (6) Yes (3) † Yes (5)
™
Compatible introducer kit Yes Yes Yes† Yes
Arterial pressure monitoring capability* Yes Yes Yes No
Femoral arterial lines for early No No No No
placement
No. of physicians capable of
ER-REBOA placement / total no. of Yes 3/10 (30) Yes 1/11 (9.1) Yes 1/5 (20) Yes 1/6 (16.6)
physicians (%)
Support staff training/familiarity, no.
familiar/total no. (%)
ER-REBOA placement 0/20 0/8 1/25 0/28
Arterial pressure monitoring ‡ 10/20 (50) 3/8 (37.5) 2/25 (8) 2/28 (7.1)
Additional survey data (scale 1–4)
Useful course? N/A N/A 3.75 § 3.28 ¶
In situ damage control resuscitation N/A N/A 3.9 § 3.5 ¶
training useful?
*Defined as having pressure tubing/pressure bag/monitor and/or readily available Compass device.
† Expired ER-REBOA and Compatible Introducer Kit.
‡ Defined as self-reported ability to set up arterial line pressure tubing/monitoring system.
§ 30 respondents.
¶ 29 respondents.
FRST = forward resuscitative surgical team; N/A = not applicable.

34 | JSOM Volume 25, Edition 3 / Fall 2025