Creating an Educational Program in the Endovascular and Hybrid Intervention; Experiences from the Japanese Society of Diagnostic and Interventional Radiology in Emergency, Critical Care, and Trauma (DIRECT)

Abstract

Diagnostic and interventional radiology (IR) techniques have recently shown significant efficacy in trauma care when combined with surgical procedures. A multifaceted approach to traffic accidents has reduced the number of trauma patients in Japan, which has necessitated simulation education to provide practical experience and ensure proficiency. The objective of this paper is to report the educational development of endovascular and hybrid workshops in Japan. The Japanese Society of Diagnostic and Interventional Radiology in Emergency, Critical care, and Trauma (DIRECT) was established in 2011 to maximize the benefit of diagnostic and IR in emergency or trauma settings. DIRECT conducts trauma endovascular workshops for emergency medicine physicians, acute care surgeons, and IR physicians. From July 2011 to June 2016, DIRECT has conducted 14 simulator workshops, six endovascular workshops using a porcine model, and four hybrid trauma management workshops, of which two were conducted with porcine models. The simulation workshop was designed for novice learners and included resuscitative endovascular balloon occlusion of the aorta (REBOA) deployment using a pressurized silicone model, catheter and guidewire manipulation with a three-dimensional (3D) vessel silicone model and virtual fluoroscopic simulator, and metallic coil deployment. Porcine simulations for intermediate-level physicians were conducted and endovascular tools included different occlusion materials. In the hybrid strategy model, by using a porcine model of injury, the participants combined both surgical and endovascular procedures such as REBOA, selective balloon occlusion, and N-butyl cyanoacrylate embolization. DIRECT is a vital bridge between emergency/trauma and IR, and workshops are essential for improved trauma care.