Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure that is potentially life-saving in major non-compressible torso hemorrhage. It may also improve outcome in non-traumatic cardiac arrest. However, the procedure can be technically challenging and requires the immediate presence of a qualified operator. Thus, evidence-based training and assessment of operator skills are essential for successful implementation and patient safety. A prerequisite for this is a valid and reliable assessment tool specific for the procedure. The aim of this study was to develop a tool for assessing procedural competence in REBOA based on best-available knowledge from international experts in the field.
We invited international REBOA-experts from multiple specialties to participate in an anonymous three-round iterative Delphi study to reach consensus on the design and content of an assessment tool. In round 1, participants suggested items to be included. In rounds 2 and 3, the relevance of each suggested item was evaluated by all participants to reach consensus. Inter-round data processing was done systematically by a steering group.
Forty panelists representing both clinical and educational expertise in REBOA from 16 countries (in Europe, Asia, North and South America) and seven different specialties participated in the study. After three Delphi rounds and 532 initial item suggestions, the panelists reached consensus on a 10-item assessment tool with behaviourally anchored rating scales. It includes assessment of teamwork, procedure time, selection and preparation of equipment, puncture technique, guidewire handling, sheath handling, placement of REBOA-catheter, occlusion, and evaluation.
We present the REBOA-RATE assessment tool developed systematically by international experts in the field to optimize content validity. Following further studies of its validity and reliability, this tool represents an important next step in evidence-based training programs in REBOA, e.g. using mastery-learning.
Level of Evidence
Criteria, level V. Expert consensus study.