Comparison of simulation models for training a diverse audience to perform resuscitative endovascular balloon occlusion of the aorta

Background: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock is increasing, but questions remain about who to train and how best to train them. We developed a REBOA training curriculum and performed a pilot course teaching the technique to surgeons and non-surgeons using four different simulation models. Methods: A REBOA curriculum was created incorporating four simulation models: (1) virtual reality, (2) mannequin, (3) large animal live tissue, and (4) perfused cadaver. The course was taught to n = 6 military personnel, including two surgeons, two emergency medicine physicians, and two non-physicians, with no prior REBOA experience. Perfor-mance using each model was recorded, and pre and post-course tests and surveys were administered. Simulation models compared capabilities, learner preferences, and cost. Results: Learners gained confidence and performed REBOA successfully in the perfused cadaver models. Higher-fidelity live tissue and cadaver models were preferred, and learners rated them as the most realistic. Virtual reality and mannequin simulation were rated the least realistic and most dispensable methods of learning. All simulation models required significant resource investment. Conclusions: A simplified curriculum, focusing only on the skills necessary to perform REBOA, shows promise in providing medical personnel with the confidence and competence to perform the procedure. Higher-fidelity per-fused cadaver and live tissue models are preferred by learners, and future work is required to improve the usefulness of mannequin and virtual reality simulation for training. Although REBOA simulation education is expensive, it has the potential to help revolutionize military and civilian prehospital hemorrhage control.