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Basic endovascular skills for trauma course: Bridging the gap between endovascular techniques and the acute care surgeon

Brenner, Megan MD, MS, RPVI; Hoehn, Melanie MD; Pasley, Jason DO; Dubose, Joseph MD; Stein, Deborah MD, MPH; Scalea, Thomas MD

Journal of Trauma and Acute Care Surgery: August 2014 - Volume 77 - Issue 2 - p 286–291
doi: 10.1097/TA.0000000000000310
Original Articles

BACKGROUND The use of catheter-based skills is increasing in the field of vascular trauma. Virtual reality simulation (VRS) is a well-established means of endovascular skills training, and potentially lifesaving skills such as resuscitative endovascular balloon occlusion of the aorta (REBOA) may be obtained through VRS.

METHODS Thirteen faculty members in the Division of Trauma and Critical Care performed REBOA six times on the Vascular Intervention System Training Simulator–C after a didactic and instructional session. Subjects were excluded if they had taken a similar endovascular training course, had additional training in endovascular surgery, or had performed this procedure in the clinical setting. Performance metrics included procedural time; accurate placement of guide wire, sheath, and balloon; correct sequence of steps; economy of motion; and safe use of endovascular tools. A precourse and postcourse test and questionnaire were performed by each subject.

RESULTS Significant improvements in knowledge (p = 0.0013) and procedural task times (p < 0.0001) were observed at the completion of the course. No correlation was observed with endovascular experience in residency, number of central and arterial catheters placed weekly, or other parameters. All trainees strongly agreed that the course was beneficial, and the majority would recommend this training to other acute care surgeons.

CONCLUSION Damage control endovascular procedures can be effectively taught using VRS. Significant improvements in procedural time and knowledge can be achieved regardless of endovascular experience in residency, years since residency, or other parameters. Novice interventionalists (acute care surgeons) can add a specific skill set (REBOA) to their existing core competencies, which has the potential to improve the survival and/or outcomes of severely injured patients.

From the R Adams Cowley Shock Trauma Center (M.B., J.P., J.D., D.S., T.S.), School of Medicine, and Division of Vascular Surgery (M.H.), University of Maryland, Baltimore, Maryland.

Submitted: February 20, 2014, Revised: April 1, 2014, Accepted: April 2, 2014.

This study was presented at the International Society of Endovascular Specialists (iCON) Annual Congress, February 13, 2014, in Phoenix, Arizona.

Address for reprints: Megan Brenner, MD, MS, RPVI, FACS, R Adams Cowley Shock Trauma Center, School of Medicine, University of Maryland, 22 S. Greene St, Baltimore, MD 21201; email:

© 2014 Lippincott Williams & Wilkins, Inc.