Hopmann Peter, Varre Jaya Sai, Duncan Gary, Devoe William B, Gable Brad D
General Surgery, OhioHealth Riverside Methodist Hospital, Columbus, USA.
Medical Education and Simulation, OhioHealth Riverside Methodist Hospital, Columbus, USA.
Cureus. 2022 Dec 22;14(12):e32820. doi: 10.7759/cureus.32820. eCollection 2022 Dec.
Background Studies have demonstrated the use of resuscitative endovascular balloon occlusion catheters of the aorta (REBOA) in the setting of postpartum hemorrhage and traumatic hemorrhagic shock. However, REBOA is infrequently utilized leading to a lack of clinician comfort. This study's aim was to demonstrate the utility of REBOA in a hemorrhaging pregnant trauma patient and improve clinician comfort with the placement of REBOA while emphasizing collaboration between medical specialties. Methods A multidisciplinary in-situ simulation was developed for the management of a pregnant patient with an abdominal gunshot wound evaluated by obstetrics and surgery teams. A trauma survey, emergency c-section, massive transfusion protocol (MTP), and evaluation for and placement of REBOA were indicated during the simulation. A standardized Return on Learning questionnaire was utilized to determine participants' reactions and confidence gained during the simulation. Results A total of 32 of 41 participants completed the survey (78%). A statistically significant increase in confidence was reported in the ability to prioritize the care of a pregnant patient with hemorrhagic shock (p = 0.016), apply MTP to the appropriate clinical setting (p = 0.03), and analyze critical decisions made for abdominal trauma in pregnant patients (p = 0.006). Specifically for physicians, a significant increase in confidence in the ability to identify indications/contraindications for REBOA placement in hemorrhaging patients was observed (p = 0.021). Conclusions A multidisciplinary simulation for the management of a pregnant patient in hemorrhagic shock secondary to penetrating abdominal trauma improved learner confidence in MTP, care of pregnant patients in hemorrhagic shock, and abdominal trauma in pregnancy. Physician learners gained confidence in indications for REBOA placement in abdominal trauma. This simulation was highly relevant to all participants.
背景 研究表明，可在产后出血和创伤性失血性休克情况下使用主动脉复苏性血管内球囊阻断导管（REBOA）。然而，REBOA很少被使用，导致临床医生对此缺乏信心。本研究的目的是证明REBOA在出血性妊娠创伤患者中的效用，并提高临床医生对REBOA放置的信心，同时强调各医学专科之间的协作。方法 针对一名腹部枪伤的妊娠患者的管理，开发了一项多学科现场模拟，由产科和外科团队进行评估。在模拟过程中，进行了创伤检查、紧急剖宫产、大量输血方案（MTP）以及REBOA的评估和放置。使用标准化的学习回报问卷来确定参与者在模拟过程中的反应和获得的信心。结果 41名参与者中有32名（78%）完成了调查。报告显示，在对出血性休克妊娠患者的护理进行优先级排序的能力（p = 0.016）、在适当的临床环境中应用MTP的能力（p = 0.03）以及分析针对妊娠腹部创伤所做的关键决策的能力（p = 0.006）方面，信心有统计学意义的显著提高。具体对于医生而言，观察到在识别出血患者中REBOA放置的适应症/禁忌症的能力方面，信心有显著提高（p = 0.021）。结论 针对穿透性腹部创伤继发出血性休克的妊娠患者管理的多学科模拟，提高了学习者对MTP、出血性休克妊娠患者护理以及妊娠腹部创伤护理的信心。医生学习者对腹部创伤中REBOA放置的适应症有了信心。该模拟与所有参与者高度相关。
