S. S. Raza1, J. Sikoutris1, B. P. Smith1, R. Dumas1, M. A. Vella1, Z. A. Qasim2, J. Guzman1, J. J. Gallagher1, P. M. Reilly1, J. W. Cannon1 1Hospital Of The University Of Pennsylvania,Division Of Traumatology, Surgical Critical Care And Emergency Surgery, Department Of Surgery,Philadelphia, PA, USA 2Hospital Of The University Of Pennsylvania,Department Of Emergency Medicine,Philadelphia, PA, USA
Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a low-frequency, high-acuity intervention. A formal skills training course remains the cornerstone of operator training and certification for REBOA placement. We hypothesize that REBOA-specific knowledge and comfort with placement deteriorate significantly within 6 months of this training if REBOA is not performed clinically in the interim.
Methods: A formal REBOA course was administered to train trauma faculty and fellows on REBOA indications and technique. This 4-hour course included a pre-course test and subjective self-assessment, followed by interactive didactics with hands-on practical training on a manikin, and concluded with a post-course test and self-reassessment. 6 months after the initial course, knowledge retention was retested and procedural comfort and number of REBOA cases reassessed for performance improvement with IRB approval. Trends in these repeated measures were evaluated with the Wilcoxon rank-sum test.
Results: A total of thirteen course participants were evaluated. Test scores improved significantly from pre-course (median 76% correct, IQR 64%-80%) to post-course (88% correct, IQR 84%-92%, p=0.002). At 6 months, retest scores (84% correct, IQR 76%-88%) remained higher than pre-course baseline scores (p=0.007) and were not significantly different than post-course scores (p=0.208) (Fig 1). At 6-month subjective assessment, comfort with femoral A-line placement and REBOA-specific knowledge also remained high with no significant difference from post-course levels. However, subjective comfort with REBOA placement at 6 months decreased significantly from post-course levels, driven primarily by participants with no clinical REBOA cases in the interim (p=0.046) (Fig 2).
Conclusion: There was no detectable deterioration in REBOA knowledge gains in the 6 months following a formal REBOA course. However, subjective comfort with REBOA placement skills decreased among participants who had not placed REBOA clinically during this time. Further longitudinal assessment is warranted to determine the appropriate interval for refresher skills training if REBOA insertion is not performed routinely.
