Simulation training streamlines the real-life performance in endovascular repair of ruptured abdominal aortic aneurysms

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http://hdl.handle.net/10138/318792

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Aho , P , Vikatmaa , L , Niemi-Murola , L & Venermo , M 2019 , ' Simulation training streamlines the real-life performance in endovascular repair of ruptured abdominal aortic aneurysms ' , Journal of Vascular Surgery , vol. 69 , no. 6 , pp. 1758-1765 . https://doi.org/10.1016/j.jvs.2018.09.026

Title: Simulation training streamlines the real-life performance in endovascular repair of ruptured abdominal aortic aneurysms
Author: Aho, Pekka; Vikatmaa, Leena; Niemi-Murola, Leila; Venermo, Maarit
Contributor: University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, Verisuonikirurgian yksikkö
Date: 2019-06
Language: eng
Number of pages: 8
Belongs to series: Journal of Vascular Surgery
ISSN: 0741-5214
URI: http://hdl.handle.net/10138/318792
Abstract: Objective: Difficulties in distributing endovascular experience among all operating room (OR) personnel prevented full-scale use of endovascular aneurysm repair (EVAR) in emergencies. To streamline the procedure of EVAR for ruptured aneurysm (rEVAR) and to provide this method even to unstable patients, we initiated regular simulation training sessions. Methods: This is an observational study of 29 simulation sessions performed between January 2015 and December 2017. We analyzed the development of time from OR door to aortic balloon occlusion during simulations and OR door to needle times in real-life rEVARs as well as the outcome of the 185 ruptured abdominal aortic aneurysm (rAAA) patients who arrived at the university hospital between January 2013 and December 2017. A questionnaire was sent for simulation attendants before and after the simulation session. Results: In the first simulations, the door to occlusion time was 20 to 35 minutes. After adding a hemodynamic collapse to the simulation protocol, the time decreased to 10 to 13 minutes in the 10 recent simulations, including a 5-minute cardiopulmonary resuscitation (P = .01). The electronic questionnaire performed for attendees before and after the simulation session showed significant improvement in both confidence and knowledge of the OR staff regarding rEVAR procedure. In the real-life rEVARs, 75 of the 185 patients with rAAAs underwent EVAR. Among rEVAR patients, the median OR door to needle time was 65 minutes before and 16 minutes after the onset of simulations (P = .000). The overall 30-day mortality among all rAAA patients was 44.8% and 30.6% accordingly (P = .046). When patients who were turned down from the emergency surgery were excluded, the 30-day operative mortality was 39.2% and 25.1% during the periods, respectively (P = .051). The 30-day mortality was 16.2% after rEVAR and 40.6% after open surgery (P = .001). Conclusions: Simulation training for rEVAR significantly improves the treatment process in real-life patients and may enhance the outcome of rAAA patients.
Subject: Ruptured abdominal aortic aneurysm
Endovascular aneurysm repair
Simulation
Mortality
PATIENT-SPECIFIC REHEARSAL
TECHNOLOGY-ENHANCED SIMULATION
EVAR
EXPERIENCE
EDUCATION
SKILLS
TRIAL
CARE
3126 Surgery, anesthesiology, intensive care, radiology
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