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Vascular access training for REBOA placement: a feasibility study in a live tissue-simulator hybrid porcine model
  1. Boudewijn L S Borger van der Burg1,
  2. T M Hörer2,
  3. D Eefting3,4,
  4. T T C F van Dongen1,5,
  5. J F Hamming4,
  6. J J DuBose6,
  7. M Bowyer7 and
  8. R Hoencamp1,4,5
  1. 1 Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
  2. 2 Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science, Örebro University Hospital, Örebro, Sweden
  3. 3 Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
  4. 4 Leiden University Medical Centre, Leiden, The Netherlands
  5. 5 Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands
  6. 6 R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA
  7. 7 Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, USA
  1. Correspondence to Boudewijn L S Borger van der Burg, Department of Surgery, Alrijne Hospital, Leiderdorp 2353GA, The Netherlands; blsborgervanderburg{at}


Background The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with severe haemorrhagic shock is increasing. Obtaining vascular access is a necessary prerequisite for REBOA placement in these situations.

Methods During the EVTM workshop (September 2017, Örebro, Sweden), 21 individuals participated in this study, 16 participants and five instructors. A formalised curriculum was constructed including basic anatomy of the femoral region and basic training in access materials for REBOA placement in zone 1. Key skills: (1) preparation of endovascular toolkit, (2) achieving vascular access in the model and (3) bleeding control with REBOA. Scoring ranged from 0 to 5 for non-anatomical skills. Identification of anatomical structures was either sufficient (score=1) or insufficient (score=0). Five consultants performed a second identical procedure as a post test.

Results Consultants had significantly better overall technical skills in comparison with residents (p=0.005), while understanding of surgical anatomy showed no difference. Procedure times differed significantly (p<0.01), with residents having a median procedure time of 3 min and 24 s, consultants 2:33 and instructors 1:09.

Conclusion This comprehensive training model using a live tissue-simulator hybrid porcine model can be used for femoral access and REBOA placement training in medical personnel with different prior training levels. Higher levels of training are associated with faster procedure times. Further research in open and percutaneous access training is necessary to simulate real-life situations. This training method can be used in a multistep training programme, in combination with realistic moulage and perfused cadaver models.

  • vascular access
  • training
  • balloon occlusion of aorta
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  • Contributors BLSBvdB, TMH and RH prepared the study set-up. BLSBvdB, DE and RH included participants and performed the study during the EVTM workshop in Orebro and collected the data. TTCFvD performed the statistical analyses. BLSBvdB, TTCFvD and RH prepared the manuscript, TTCFvD prepared the tables and figures. BLSBvdB, TMH, DE, TTCFvD, JFH, JJD, MB and RH contributed to the final version of the paper.

  • Funding Prytime Medical Devices, Inc. provided the ER-REBOA catheters used for this animal study.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was conducted under a protocol reviewed and approved by the Dutch Ministry of Defense (MoD) and both the Institutional Review Board and Medical Ethical Committee of Alrijne Hospital, the Netherlands (NWMO 17-15, and Örebro University Hospital (dnr 124-11 and dnr 105/10 Örebro university, hospital surgical division). All participants completed an informed consent to participate in this study, including permission for video recording and publishing of the results and photographic materials. These consent forms are available on request.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Availability of data and supporting materials section – All data is available for review. Please contact author for data requests.

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