EndoVascular hybrid Trauma and bleeding Management (evtm) Hands-on workshop



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Dept. of Cardiothoracic and Vascular Surgery, Dr. Tal Hörer

2016-09-18



EndoVascular hybrid Trauma and bleeding Management (EVTM)

Hands-on workshop (preliminary info)

cid:24bf4738-733e-486c-9180-67b230bab744

Örebro, 1-2 February 2017 (pre-meeting workshop)

Endovascular and hybrid solutions for the bleeding patient; Aorta balloon occlusion (REBOA) usage, vascular access and techniques

Thomas Larzon MD, PhD, Asko Toivola MD, Artai Pirouzram MD, Rickard Lindgren MD, PhD, Per Skoog MD, PhD, Kristofer Nilsson MD PhD and Tal Hörer MD, PhD.

Dept. Cardiothoracic and Vascular Surgery, Dept. of General Surgery

Örebro University Hospital, Sweden.



Guest faculty and cooperation with the Japanese society of diagnostic and interventional radiology in emergency, critical care and trauma (DIRECT). Led by Junichi Matsumoto and yousuke Matsumura

Visiting faculty (final TBA):

Charles Fox (vascular surgeon) USA

Melenie Hoehn (Vascular surgeon) USA

John Holcomb (Trauma surgeon) USA

Jonny Morrison (Vascular surgeon), UK

Daniel Eefting (Vascular surgeon) NL

Lauri Handolin (Trauma surgeon) FN

Viktor Reva (Trauma surgeon) RU

Target: Surgeons with trauma interest, Emergency trauma teams/doctors, ER and military trauma teams. Intensivists with interest in trauma.

Date: 1-2 February 2017 at Örebro University Hospital Training center and animal lab

Registration: Malmö Congress Office (MKB) via http://www.jevtm.com/evtm-symposium/

Course Director: Dr. Tal Hörer MD, PhD Associate Professor of Surgery

Live Feeds by Association Ltd, Stockholm

Partners: TOKAI (Rescue Balloon, main partner for the workshop), BBraun, Cook Medical, Mentice, 3dimprimo, STILLE, Ziehm , Mentice, TBA

Objectives:

The main aim of this WS is to get a discussion and practice platform of endovascular hybrid Trauma & bleeding management (EVTM) using a multidisciplinary approach. Main issue is the vascular access, obtained by different methods (blind, Doppler, ultrasound, fluoroscopy and surgical access), usage in bleeding patients for temporary and permanent bleeding control. The usage of Aorta Balloon Occlusion (ABO/REBOA), as well as basic stents and embolization methods will be practiced. Bailout and alternative methods will be discussed and practiced. Basic postoperative considerations as intra-abdominal pressure monitoring will be practiced. Participant’s cases as well as ABOTrauma Registry cases will be discussed. The WS includes basic material knowledge, dry models as well as intensive training on live tissue. The WS give the basics for building a “REBOA or EVTM service” by the participants needs. The workshop is built for experienced physicians and adjusted to individual level during the practical moments. Participants will get all basic training and knowledge for REBOA placement as part of the EVTM concept.

Day 1 (1st February): Clinical Training Center (KTC), USÖ

Endovascular trauma algorithm, theory on access and methods, physiology of REBOA/pREBOA/iREBOA and literature. Use of access, aortic/arterial balloon occlusion and other tools for the bleeding patient. Dry model training and Mentice© simulator training. Group discussion of participant’s cases and ABOTrauma registry cases. Building a REBOA/EVTM service. Final details TBA

11:45 Gathering in the training centrum second floor

12:00-12:30 Lunch at the training center, Welcome and general Information (Tal H)

10 minutes’ presentations and short discussions (coffee served during the session)

Final program TBA

12:30- 12:40 EVTM, the concept (Tal H)

12:40-12:50 Basic material and how to think; The REBOA kit you need (P Skoog, A Priouzram)

12:50-13:00 Lessons from aneurysm ruptures- vascular access & more (T Larzon); Q&A

13:10- 13:20 Pelvic bleeding and REBOA- (Charles Fox); Q&A

13:30-13:45 The Japanese REBOA experience; lessons (Jun M/Yosuke M)

13:45-13:55 REBOA updates-what’s important to know? Complications (V Reva); Q&A

14:00-14:10 REBOA role in trauma – Rationale; How can I use it? (L Handolin); Q&A

14:15-14:25 EVTM in Shock&Trauma Baltimore? Lessons (M Hoehn.)

14:30-15:00 Discussion & Cases #1 (Participants, Faculty, ABOTrauma registry).

15:00-15:15 REBOA Updates-What do we know about REBOA/indications? (J Morrison)

15:15-15:30 Vascular access- how to think and what to avoid? (D Eefting)

15:30-15:45 pREBOA, iREBOA and lab data (M Sadeghi/T Hörer/K Nilsson)

15:45-16:15 EVTM methods Q&A: discussion (led by A. Pirouzram and faculty)

16:20-19:00 Practical training in stations:

Practical scenario on a training model with REBOA and more (45 min).

Aorta 3D models. Ultrasound station. C-arm usage, Angiography table, Mentice simulator trauma station. Practice and discussion with faculty in groups. Material for endo-trauma and hybrid management. The “ABO/ERBOA trolley”. Over the wire method (Seldinger) on dry model; Blind and ultrasound guided. Introducers and upgrading, REBOA, iREBOA and pREBOA. Basic ultrasound management for access is available.



Around 19:00 Departure to dinner - TBA

Day 2 (2 February): Animal lab training & research center, USÖ

07:15-08:30 Cadaver “EVTM anatomical review- what can we do?” including REBOA practical practice (Preliminary-if available case, to be announced the day before).

08:40-09:00 Breakfast with the industry (training center)

09:00-13:00 Animal lab: Hands-on animal lab including vascular and endovascular access. ABO principles and practice. Basic angiography training and embolization. Basic ultrasound guided access. Hybrid procedures. Lunch and coffee will be served in the lab. Every station with highly experienced faculty and one-on-one training as well as group scenario discussions on live tissue.

Practical training points in the animal lab:

1) Material usage in bleeding patients, general considerations. The trauma-bay kit.

2) Vascular Access basic principles. Dissection techniques for access, Endoshunts (and shunts), hybrid procedures and other techniques. Puncture; Seldinger technique, ultrasound, blind, fluoroscopy, cut down.

3) Upgrading/introducers/guide wires. The failing access/alternatives including retroperitoneal, conduit, axillar etc. Access on venous side.

4) REBOA: Material and REBOA kit, practical deployment and using the ABO. Deflation and re-position issues; Intermitted/Partial inflation with MAP as target - pREBOA). Ongoing bleeding practice!

- Case discussions #2 during training.

5) Balloons in other locations (Iliac, Subclavian, and Brachiocephalic trunk/zone I neck), Sizing and techniques.

6) Aortography and Angiography considerations (type, volume etc.) Embolization in target vessels: Material, access, coils, Onyx. Stent graft deployment (basic issues) practice. Pelvic bleeding

7) Endo-damage control; Bail-out methods; fascia suture, cut down. Doppler control and completion angio. Measuring Intra-abdominal pressure.

8) Bleeding management scenarios on live tissue will be in cooperated



The workshop will end by 13:00

Workshop director: Tal Hörer, Örebro University Hospital, tal.horer@regionorebrolan.se +46196024632 (direct)/+46702383495 (cellular)

Course secretary: Malmö Congress Center via http://www.jevtm.com/evtm-symposium/

More info on www.jevtm.com under workshop



Dept. of Cardiothoracic and Vascular Surgery contact: chatarina.lindahl@regionorebrolan.se


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