Design of a cost-effective, hemodynamically adjustable model for resuscitative endovascular balloon occlusion of the aorta (REBOA) simulation.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct technique for salvaging patients with noncompressible torso hemorrhage. Current REBOA training paradigms require large animals, virtual reality simulators, or human cadavers for acquisition of skills. These training strategies are expensive and resource intensive, which may prevent widespread dissemination of REBOA. We have developed a low-cost, near-physiologic, pulsatile REBOA simulator by connecting an anatomic vascular circuit constructed out of latex and polyvinyl chloride tubing to a commercially available pump. This pulsatile simulator is capable of generating cardiac outputs ranging from 1.7 to 6.8 L/min with corresponding arterial blood pressures of 54 to 226/14 to 121 mmHg. The simulator accommodates a 12 French introducer sheath and a CODA balloon catheter. Upon balloon inflation, the arterial waveform distal to the occlusion flattens, distal pulsation within the simulator is lost, and systolic blood pressures proximal to the balloon catheter increase by up to 62 mmHg. Further development and validation of this simulator will allow for refinement, reduction, and replacement of large animal models, costly virtual reality simulators, and perfused cadavers for training purposes. This will ultimately facilitate the low-cost, high-fidelity REBOA simulation needed for the widespread dissemination of this life-saving technique.
From the University of California, Davis Medical Center Department of Surgery (B.A.K., E.S.S., A.J.C., J.M.G.), Sacramento, California; David Grant Medical Center, Department of Vascular and Endovascular Surgery (T.K.W.), Travis Air Force Base, California, UCDMC Affiliate, David Grant Medical Center, Department of Surgery (L.P.N.), Travis Air Force Base, California, UCDMC Affiliate; University of California, Davis, Department of Biomedical Engineering (Y.L.,O.G), Davis, California; and University of California, Davis Medical Center, Department of Pathology and Laboratory Medicine (N.K.T.), Sacramento, California.
Benjamin A
BA
Keller
Edgardo S
ES
Salcedo
Timothy K
TK
Williams
Lucas P
LP
Neff
Anthony J
AJ
Carden
Yiran
Y
Li
Oren
O
Gotlib
Nam K
NK
Tran
Joseph M
JM
Galante
D001011:Aorta; D021721:Balloon Occlusion / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000193:education*; D004867:Equipment Design; D006439:Hemodynamics; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D012151:Resuscitation / Q000193:education*; D000066908:Simulation Training / Q000379:methods*; D014194:Traumatology / Q000193:education*