Background : Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a less invasive alternative to thoracotomy prior to hemodynamic collapse due to noncompressible thoracoabdominal hemorrhage. Effective performance of REBOA and other endovascular techniques are critical but infrequently used skills in Emergency Medicine. The ability to practice these techniques on low-cost, physical models of sufficient fidelity builds confidence and proficiency prior to execution while avoiding the inherent drawbacks found with cadaver, animal, and virtual reality simulators.
Purpose/Objective : The objective is to create a low-cost, reusable REBOA task trainer to allow novice operators to gain experience in placing arterial endovascular occlusion devices with specific focus on ultrasound compatibility, realistic vascular anatomy, and physiologic haptic feedback.
Methods : 1.) Design an endovascular groin access module with ultrasound compatibility, self-sealing vasculature, and physiologic haptic feedback on needle insertion. 2.) Develop translucent 3D anatomic vessel models of the aorta and its major branches capable of withstanding physiologic pressures, pulsatile flows, and repeated endovascular manipulations. 3.) Optimize a pulsatile flow circulation system to mimic the mechanical forces experienced by the thoracoabdominal aorta and peripheral vasculature. 4.) Develop a reliable and inexpensive mannequin-based REBOA training system.
Outcomes : This novel trainer allows REBOA catheter insertion under ultrasound guidance into a pulsatile, arterial flow circuit simulating noncompressible hemorrhage with haptic feedback. Short-run production costs range: $2000-$2500. Economy of scale may reduce cost up to 20%. This system remains cost competitive as a reusable, physical endovascular trainer when compared to the minimally reusable cadaver and animal alternatives as well as highly expensive virtual reality trainers that lack the necessary catheter insertion experience.