主动脉球囊阻断复苏术（REBOA）在非创伤性院外心脏骤停中的应用：一项教育计划的评估。

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme.

机构信息

Department of emergency medicine and pre-hospital services, St. Olavs Hospital, Trondheim, Norway.

Departmentof research and development, Norwegian Air Ambulance Foundation, Oslo, Norway.

出版信息

BMJ Open. 2019 May 9;9(5):e027980. doi: 10.1136/bmjopen-2018-027980.

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation during cardiopulmonary resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data support that patients in non-traumatic cardiac arrest might benefit from REBOA in the thoracic level during CPR. This study describes a training programme to implement the REBOA procedure to a prehospital working team, in preparation to a planned clinical study.

METHODS

We developed a team-based REBOA training programme involving the physicians and paramedics working on the National Air Ambulance helicopter base in Trondheim, Norway. The programme consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application scoring chart and a special designed simulation mannequin was made for this study.

RESULTS

Seven physicians and 3 paramedics participated. The time needed to perform the REBOA procedure was 8.5 (6.3-12.7) min. The corresponding time from arrival at scene to balloon inflation was 12.0 (8.8-15) min. The total objective assessment scores of the candidates' competency was 41.8 (39-43.5) points out of 48. The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure.

CONCLUSION

This four-step approach to educate, train and implement the REBOA procedure to a prehospital working team ensures adequate competence in a simulated OHCA setting. The use of a structured training programme and objective assessment of skills is recommended before utilising the procedure in a clinical setting. In a simulated setting, the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS.

TRIAL REGISTRATION NUMBER

NCT03534011.

背景

院外心脏骤停（OHCA）是一种死亡率很高的危急事件。心肺复苏（CPR）期间循环的增强可能是有益的。使用主动脉球囊阻断复苏术（REBOA）可将心输出量重新分配到阻塞部位近端的器官。临床前数据支持，非创伤性心脏骤停患者在 CPR 期间可能受益于胸部水平的 REBOA。本研究描述了一个培训计划，旨在为一个准备进行的临床研究，向一个院前工作团队实施 REBOA 程序。

方法

我们开发了一个基于团队的 REBOA 培训计划，涉及在挪威特隆赫姆的国家空中救护直升机基地工作的医生和护理人员。该计划包括一个四步方法，用于在模拟院前环境中教育、培训和实施 REBOA 程序。为此研究制作了一个客观的结构化评估院前 REBOA 应用评分表和一个特殊设计的模拟人体模型。

结果

7 名医生和 3 名护理人员参加了培训。实施 REBOA 程序所需的时间为 8.5（6.3-12.7）分钟。从到达现场到气球充气的相应时间为 12.0（8.8-15）分钟。候选人的综合客观评估得分为 41.8（39-43.5）分。无论同时进行 REBOA 程序与否，高级心血管生命支持（ACLS）的质量都保持标准。