W. Teeter1, M. L. Brenner1,2, M. R. Hoehn2, D. S. Stein1, T. Scalea1 1University Of Maryland,Division Of Trauma And Critical Care,Baltimore, MD, USA 2University Of Maryland,Division Of Vascular Surgery,Baltimore, MD, USA
BACKGROUND: The use of catheter-based techniques is increasing in the field of trauma. Virtual reality simulation (VRS) is a well-established means of endovascular skills training, and other simulation skills are now mandatory for board-eligibility in general surgery. Training for emerging endovascular damage control skills in trauma, including resuscitative endovascular balloon occlusion of the aorta (REBOA), may be obtained by residents through VRS.
Methods: Fifteen trainees in either an ACGME-approved General Surgery or Surgical Critical Care Fellowship at one institution received didactic and instructional sessions on REBOA. The subjects performed the procedure 6 times. Subjects were excluded if they had taken a similar endovascular training course, had post-graduate training in endovascular surgery, or had performed the procedure in the clinical setting. Performance metrics were measured on a Likert scale, and 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 pre- and post-course test and questionnaire were completed by each subject.
Results: Fifteen subjects, with a mean PGY level of 4.9 years (SD±0.95) participated in the study. Significant improvements in knowledge (p < 0.0001, CI 95%), as assessed by a standardized exam, were observed at the completion of the course. Procedural task times significantly improved from a mean of 207 seconds (SD ± 19.9) to 107 seconds (SD ± 20.6)[(p < 0.0001, CI 95%] (Fig 1). No correlation was observed with endovascular experience in residency, number of endoluminal catheters placed per week, or other parameters. All trainees strongly agreed that the course was beneficial, and the majority would recommend this training to other trainees.
Conclusion: Damage control endovascular skills can be effectively acquired using VRS. Significant improvements in procedural time and knowledge can be achieved regardless of previous endovascular experience or area of training. Novice interventionalists such as surgical trainees can add a specific skill set (REBOA) to their existing core competencies. Use of this procedure in the clinical setting will determine if VRS for REBOA training confers validation metrics such as transfer of skills.