Related Experiment Video
Updated: Oct 29, 2025
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Developing a tool to assess competence in resuscitative endovascular balloon occlusion of the aorta: An international
Morten Engberg1, Tal Hörer, Todd E Rasmussen
1From the Centre for Human Resources and Education, Capital Region of Denmark (M.E., L.J.N., L.R., L.K.), Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Department of Clinical Medicine (M.E., N.K.R., L.K., L.L.), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiothoracic and Vascular Surgery (T.H.), and Department of Surgery (T.H.), Faculty of Life Science, Örebro University Hospital, Örebro, Sweden; Walter Reed National Military Medical Center (T.E.R.); National Institutes of Health Clinical Center (T.E.R.), Bethesda, Maryland; Department of Radiology (M.T., N.K.R., L.L.), and Department of Intensive Care (L.R.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Background:
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure that is potentially lifesaving in major noncompressible torso hemorrhage. It may also improve outcome in nontraumatic cardiac arrest. However, the procedure can be technically challenging and requires the immediate presence of a qualified operator. Thus, evidence-based training and assessment of operator skills are essential for successful implementation and patient safety. A prerequisite for this is a valid and reliable assessment tool specific for the procedure. The aim of this study was to develop a tool for assessing procedural competence in REBOA based on best-available knowledge from international experts in the field.
Methods:
We invited international REBOA experts from multiple specialties to participate in an anonymous three-round iterative Delphi study to reach consensus on the design and content of an assessment tool. In round 1, participants suggested items to be included. In rounds 2 and 3, the relevance of each suggested item was evaluated by all participants to reach consensus. Interround data processing was done systematically by a steering group.
Results:
Forty panelists representing both clinical and educational expertise in REBOA from 16 countries (in Europe, Asia, and North and South America) and seven different specialties participated in the study. After 3 Delphi rounds and 532 initial item suggestions, the panelists reached consensus on a 10-item assessment tool with behaviorally anchored rating scales. It includes assessment of teamwork, procedure time, selection and preparation of equipment, puncture technique, guidewire handling, sheath handling, placement of REBOA catheter, occlusion, and evaluation.
Conclusion:
We present the REBOA-RATE assessment tool developed systematically by international experts in the field to optimize content validity. Following further studies of its validity and reliability, this tool represents an important next step in evidence-based training programs in REBOA, for example, using mastery learning.
Level Of Evidence:
Therapeutic, level V.
