Dept. of Cardiothoracic and Vascular Surgery, Dr. Tal Hörer / 2015-12-25
EndoVascular and HybridTrauma management (EVTM)
Hands-on workshop
Örebro, 22-23 September 2016
Endovascular solutions for the bleeding patient; Aorta Balloon Occlusion (ABO/REBOA) usage, vascular access and techniques
Thomas Larzon MD, PhD, Asko Toivola MD, Artai Pirouzram MD, Rickard Lindgren MD, PhD, Per Skoog MD, PhD and Tal Hörer MD, PhD. Örebro University Hospital, Sweden.
Guest faculty and cooperationof the Japanese society of diagnostic and interventional radiology in emergency, critical care and trauma (DIRECT). Led by Junichi Matsumoto
Visiting faculty:
MårtenFalckenberg MD, PhD, Göteborg, Sweden (vascular/IR)
Lauri Handolin MD, PhD Helsinki (Trauma)
Viktor Reva MD, PhD St.Petersburg, Russia(Vascular/Trauma)
Jan Holst MD, PhD Malmö, Sweden (Vascular)
Target: Surgeons with trauma interest, emergency trauma teams/doctors, ER and military trauma teams.
Date:22-23 September 2016 at Örebro University Hospital Training center and animal lab
Registration: Course DirectorTal Hörer
Partners: TOKAI (Rescue Balloon), Ziehmimaging, MelioraMedtech, Mentice, STILLE, Takeda, 3Dimprimo, WlGore, Cook medical, Penumbra, Toshiba, Philips, Siemens.(preliminary announced partners)
Objectives:
The main aim of this WS is to get a discussion and practice platform of endovascular and hybrid bleeding/Trauma 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 methods 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.
Day 1 (22 sept): Clinical Training Center (KTC), USÖ
Endovascular trauma algorithm, case discussions, theory on access and methods,physiology of ABO/REBOA, literature. Use of access, ABO and other tools for the bleeding patient. Dry model training andMentice©simulator training.Group discussion of participant’s cases and ABOTrauma registry cases.
12:00-12:30Lunch at the training center, Welcome and general Information (Tal)
12:30- 12:50EVTM concept (Tal H)
12:50-13:00Basic materialand how to think (Artai P)
13:00-13:15Lessons from ruptures- the vascular access and more(Thomas L)
13:15- 13:30Pelvic bleeding- what to do/how? How can IR help you (Mårten F)
13:30-13:45The Japanese experience and Presto concept; Pelvic bleeders (Jun M)
13:45-15:00 REBOA updates- how to do?(Viktor R)
15:00-15:10 EVTM role in trauma- view of the trauma surgeons (Lauri H)
15:20-15:40 Q&A and discussionVideo TBA (Coffee served)
15:50-17:00Case discussions #1 (Participants, Faculty, ABOTrauma registry).
17:00- 19:00Practical stations: Aorta models. Ultrasound station. 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, ABO/REBOA and pABO. Basic ultrasound management for access.
Around 19:00Departure to dinner (to be announced)
Day 2 (23 Sept): Animal Lab, USÖ
07:15-08:15Cadaver “EVTManatomical review- what can we do?”including ABO/REBOA practice (Preliminary-if available case, to be announced the day before). TH/VR/LH
08:30-09:00 Breakfast with the industry
09:00-15:30 Animal lab: Hands on animal lab including vascular and endovascular access. ABOprinciples and practice. Basic angiography training and embolization.Basic ultrasound guided access.Hybrid procedures. Lunch and coffeewill be served in the lab.
Practical training points in the animal lab:
1) Material usage in bleeding patients, general considerations. The trauma-bay kit.
2) 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) ABO:Material, practical deployment and using the ABO. Deflation and re-position issues; Intermitted/Partial inflation with MAP as target (pABO).
-Case discussions #2 (Participants, Faculty, ABOTrauma registry) During Lunch.
5) Balloons in other locations (Iliac, Subclavian, and Brachiocephalictrunk/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.MeasuringIntra-abdominal pressure.
8) Trauma management scenarios on live tissue will be in cooperated
Course secretary:Mrs. ChatarinaLindahl,
We would like to thank our partners from the industry for their contribution