Borger van der Burg Boudewijn L S, Hörer T M, Eefting D, van Dongen T T C F, Hamming J F, DuBose J J, Bowyer M, Hoencamp R
Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science, Örebro University Hospital, Örebro, Sweden.
J R Army Med Corps. 2019 Jun;165(3):147-151. doi: 10.1136/jramc-2018-000972. Epub 2018 Sep 17.
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.
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.
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.
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.
在严重失血性休克患者中，复苏性血管内球囊阻断主动脉（REBOA）的应用正在增加。在这些情况下，获得血管通路是放置REBOA的必要前提。
在2017年9月于瑞典厄勒布鲁举行的血管内治疗模拟培训研讨会上，21人参与了本研究，其中16名参与者和5名教员。构建了一个正式课程，包括股部区域的基础解剖学以及在1区放置REBOA的通路材料基础培训。关键技能：（1）血管内工具包的准备，（2）在模型中实现血管通路，以及（3）用REBOA控制出血。非解剖学技能的评分范围为0至5分。解剖结构的识别要么充分（评分=1）要么不充分（评分=0）。5名顾问在测试后进行了第二次相同的操作。
与住院医师相比，顾问的总体技术技能明显更好（p=0.005），而对外科解剖学的理解没有差异。操作时间有显著差异（p<0.01），住院医师的中位操作时间为3分24秒，顾问为2分33秒，教员为1分09秒。
这种使用活组织模拟混合猪模型的综合培训模式可用于对具有不同先前培训水平的医务人员进行股动脉通路和REBOA放置培训。更高水平的培训与更快的操作时间相关。有必要对开放和经皮通路培训进行进一步研究以模拟现实情况。这种培训方法可用于多步骤培训计划，结合逼真的人体模型和灌注尸体模型。
