The management of hemorrhage shock requires support of central aortic pressure including perfusion to the brain and heart as well as measures to control bleeding. Emerging endovascular techniques including resuscitative endovascular balloon occlusion of the aorta serve as potential lifesaving adjuncts in this setting. The Endovascular Skills for Trauma and Resuscitative Surgery (ESTARS) course was developed to provide fundamental endovascular training for trauma surgeons.
ESTARS 2-day course incorporated pretest/posttest examinations, precourse materials, lectures, endovascular and open vascular instruments, Vascular Intervention System Trainer endovascular simulator, and live animal laboratories for training and testing. Curriculum included endovascular techniques for trauma; review of wires, sheaths, and catheters; as well as regional vascular injury management. Animal laboratories integrated arterial access, angiography, coil embolization, resuscitative endovascular balloon occlusion of the aorta, control of iliac artery injury, and vascular shunt placement. Students completed a knowledge test (precourse/postcourse) and a summative skills assessment. The test measured knowledge and judgment in vascular injury management as defined in the course objectives. Vascular Intervention System Trainer and animal laboratory were used for final examinations. Subjective performance was graded by expert observers using a global assessment scale and performance metrics.
Four pilot ESTARS courses were completed, with four participants each. Knowledge and performance significantly improved after ESTARS. Mean test examination scores increased by 77% to 85%, with a mean change of 9 percentage points [paired t (15) = 7.82, p < 0.0001]. The test was unidimensional (Cronbach’s α = 0.67). Technical skill significantly improved for both endovascular simulation and live animal laboratory examinations. All participants passed the live animal laboratory practical examination.
The ESTARS curriculum is effective at teaching a basic set of endovascular skills for resuscitation and hemorrhage control to trauma surgeons. ESTARS was confirmed as a stepwise and hierarchical curriculum demonstrating measurable improvements in performance metrics and should serve as a model for future competency-based structured training in endovascular trauma skills.
From the University of Texas San Antonio (C.Y.V.); University of Michigan (J.L.E., L.M.N., R.B.S.); Clinical Research Division (J.R.S.), Lackland Air Force Base San Antonio; Institute of Surgical Research (T.E.R.), Fort Sam Houston, Texas.
Submitted: September 13, 2013, Revised: November 4, 2013, Accepted: December 16, 2013.
This study was presented at the 72nd annual meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery, September 18–21, 2013, in San Francisco, California.
Address for reprints: Lena M. Napolitano, MD, Department of Surgery, University of Michigan Health System, Room 1C340A-UH, University Hospital, 1500 East Medical Dr, Ann Arbor, MI 48109-0033; email: firstname.lastname@example.org.