Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme

Jostein Rødseth Brede; Thomas Lafrenz; Andreas J Krüger; Edmund Søvik; Torjus Steffensen; Carlo Kriesi; Martin Steinert; Pål Klepstad

doi:10.1136/bmjopen-2018-027980

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme

BMJ Open. 2019 May 9;9(5):e027980. doi: 10.1136/bmjopen-2018-027980.

Authors

Jostein Rødseth Brede^{1

2

3}, Thomas Lafrenz⁴, Andreas J Krüger^{1

2

3}, Edmund Søvik⁵, Torjus Steffensen⁶, Carlo Kriesi⁶, Martin Steinert⁶, Pål Klepstad^{3

7}

Affiliations

¹ Department of emergency medicine and pre-hospital services, St. Olavs Hospital, Trondheim, Norway.
² Departmentof research and development, Norwegian Air Ambulance Foundation, Oslo, Norway.
³ Department of circulation and medical imaging, NTNU, Trondheim, Norway.
⁴ Department of thoracic anesthesiology and intensive care medicine, St. Olavs Hospital, Trondheim, Norway.
⁵ Department of radiology and nuclear medicine, St. Olavs Hospital, Trondheim, Norway.
⁶ Department of mechanical and industrial engineering, NTNU, Trondheim, Norway.
⁷ Department of anesthesiology and intensive care medicine, St. Olavs Hospital, Trondheim, Norway.

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation during cardiopulmonary resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data support that patients in non-traumatic cardiac arrest might benefit from REBOA in the thoracic level during CPR. This study describes a training programme to implement the REBOA procedure to a prehospital working team, in preparation to a planned clinical study.

Methods: We developed a team-based REBOA training programme involving the physicians and paramedics working on the National Air Ambulance helicopter base in Trondheim, Norway. The programme consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application scoring chart and a special designed simulation mannequin was made for this study.

Results: Seven physicians and 3 paramedics participated. The time needed to perform the REBOA procedure was 8.5 (6.3-12.7) min. The corresponding time from arrival at scene to balloon inflation was 12.0 (8.8-15) min. The total objective assessment scores of the candidates' competency was 41.8 (39-43.5) points out of 48. The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure.

Conclusion: This four-step approach to educate, train and implement the REBOA procedure to a prehospital working team ensures adequate competence in a simulated OHCA setting. The use of a structured training programme and objective assessment of skills is recommended before utilising the procedure in a clinical setting. In a simulated setting, the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS.

Trial registration number: NCT03534011.

Keywords: cardiology.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Air Ambulances
Aorta, Thoracic*
Balloon Occlusion / methods*
Clinical Competence
Endovascular Procedures / education*
Endovascular Procedures / methods
Humans
Manikins
Norway
Out-of-Hospital Cardiac Arrest / therapy*
Program Evaluation
Resuscitation / education*
Resuscitation / methods
Simulation Training / methods*

Associated data

ClinicalTrials.gov/NCT03534011