Resuscitative Endovascular Balloon Occlusion of the Aorta Process Improvement: Examining a Novel Case Evaluation Tool and Standardized Simulations

A quality improvement project was undertaken. The objectives of this study were to describe an original case evaluation tool, discuss barriers encountered, present a standardized simulation course, and evaluate the efficacy of this course. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging adjunct in the trauma bay for patients with noncompressible subdiaphragmatic hemorrhage. Compared with the alternative (emergency department thoracotomy), it is less invasive and allows for continuation of chest compressions, and early studies suggest a positive effect on mortality. Infrequent utilization of REBOA limits provider and support staff exposure to its indications and technical skills required to deploy the device. Furthermore, there is no standardized evaluation tool for collecting and reporting REBOA-related data. The REBOA Review Tool was designed to easily evaluate all the steps involved in deploying the REBOA tool and was implemented at our institution without difficulty. This tool provided meaningful feedback for areas that required improvement including ease of information retrieval and documentation of sheath removal. Standardized simulation courses were performed to further improve provider and support staff confidence in using the REBOA tool. Analysis of pre- and postsimulation surveys showed significant improvement in participants' confidence in their understanding and utilization of the REBOA tool and its indications. REBOA placement is a low-volume but high-impact procedure. Therefore, simulations to prepare and a standardized tool to learn from prior experience are vital to improving patient care.