The journal of trauma and acute care surgery · 2025
Five to excellence: The path to resuscitative endovascular balloon occlusion of the aorta proficiency.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Moore Ernest E, Lopez Jorge, Raley Jessica, Spalding Chance, Mukherjee Kaushik, Radomski Michal, Nguyen Jonathan, Beckett Andrew, Smith Allison, Rezende-Neto Joao, Vassy Matthew, Dennis Bradley
Аннотация
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergent intervention for life-threatening hemorrhage, yet its clinical adoption is inconsistent, often because of technical challenges and variability in training. This study aims to characterize the learning curve associated with the pREBOA-PRO catheter Prytime Medical (Boerne, TX) at both the individual surgeon and institutional levels.
METHODS: Between March 2021 and June 2024, 377 REBOA procedures were performed at select Level I trauma centers as part of a quality improvement initiative. Structured debriefings were conducted within 48 hours postprocedure to assess technical challenges in three domains: femoral access, catheter removal, and sheath management. Learning curves were analyzed using cubic regression models for 24 surgeons (each with ≥8 cases; 251 cases total) and 8 institutions (each with ≥20 cases; 330 cases total).
RESULTS: Technical challenges were most frequent during the initial 5 cases for individual surgeons (63%) and the first 10 cases for institutions. Catheter removal emerged as the most common challenge (37% for individuals, 46% for institutions). Cubic regression models best fit the learning curves, demonstrating a marked reduction in technical issues by the fifth case for individuals and the tenth for institutions. Statistically significant differences in challenge rates were observed between early and later cases ( p < 0.01).
CONCLUSION: Resuscitative endovascular balloon occlusion of the aorta demonstrates a relatively short learning curve, with proficiency typically achieved after 5 cases for individual surgeons and 10 for institutions. Focused training in vascular access, sheath management, and catheter removal is essential to optimize performance. These findings support the feasibility of rapid adoption of REBOA in high-volume centers and potentially in resource-limited settings, emphasizing the importance of structured training programs to enhance procedural proficiency and patient outcomes.
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.
METHODS: Between March 2021 and June 2024, 377 REBOA procedures were performed at select Level I trauma centers as part of a quality improvement initiative. Structured debriefings were conducted within 48 hours postprocedure to assess technical challenges in three domains: femoral access, catheter removal, and sheath management. Learning curves were analyzed using cubic regression models for 24 surgeons (each with ≥8 cases; 251 cases total) and 8 institutions (each with ≥20 cases; 330 cases total).
RESULTS: Technical challenges were most frequent during the initial 5 cases for individual surgeons (63%) and the first 10 cases for institutions. Catheter removal emerged as the most common challenge (37% for individuals, 46% for institutions). Cubic regression models best fit the learning curves, demonstrating a marked reduction in technical issues by the fifth case for individuals and the tenth for institutions. Statistically significant differences in challenge rates were observed between early and later cases ( p < 0.01).
CONCLUSION: Resuscitative endovascular balloon occlusion of the aorta demonstrates a relatively short learning curve, with proficiency typically achieved after 5 cases for individual surgeons and 10 for institutions. Focused training in vascular access, sheath management, and catheter removal is essential to optimize performance. These findings support the feasibility of rapid adoption of REBOA in high-volume centers and potentially in resource-limited settings, emphasizing the importance of structured training programs to enhance procedural proficiency and patient outcomes.
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.