The incidence of ruptured abdominal aortic aneurysms (rAAA) has declined, but it is still a fatal situation. Several teams treat less than twenty cases per year and face a critical condition requiring perfect teamwork. A standard¬ised patient pathway for rAAA management and a reli¬able multidisciplinary team are the keys to improving patient outcomes. It is necessary to provide training opportunities in a real scenario but without the pressure of a vital emergency(1-3). We present an innovative multidisciplinary training project that objectively measures the degree of improvement of the team.

After developing the Ruptured Abdominal Aortic Aneurysm (rAAA) protocol, we designed a multidisciplinary course to improve training and response time. The course had simulation sessions in a hybrid theatre (Azurion, Philips®) which were video recorded for further analysis. Everybody signed informed consent for the use of images. The course consisted of three parts: 1. We performed a simulation session in a natural environment where the different professionals Vascular Surgeon (VS), Anesthesiologist (ANR), Nurses (N) and Caretakers (C), reproduced the management of a newly diagnosed patient. 2. We designed a second session, specific to each professional group, to perform a theoretical protocol revision, especially dealing with the areas of interest of every group. In addition, we reviewed the simulations' videos, analyzing everybody's performance. 3. Finally, we performed a second simulation session to apply the improvements detected in the previous sessions. Performance improvement and degree of satisfaction were analyzed by measuring response time from the emergency call to the stabilization of the patient with an intraortic balloon and by a six-question survey that all participants completed before and after the simulations using a Likert Scale (1 strongly disagree, 5 strongly agree). We carried out a final course evaluation survey.

A total of 33 participants completed the course (10 VS, 8 ANR, 12 N and 3 C). We compared the pre and post-simulation valuations. Regarding question 1 (I feel confident with my abilities), 71% valued ≥4 in the pre and 73% in the post. Questions 2, 3 and 4 represented the most remarkable evolution in knowledge (assessment ≥4), going from 70% to 97% in question 2 (I know my role during surgery), from 50% to 74% in question 3 (I manage well during surgery setting), from 62% to 80% in 4 (I am aware of the role of my colleagues). The answers to 5 (I have enough experience to carry out the treatment of an AAAR) went from 30 to 46%. All participants answered ≥4 to question 6 (I consider the simulation useful for my training). We saw a reduction in response time from 42.3 minutes to 31.3 minutes (25% reduction). In the final evaluation survey of the course, all responses were ≥4.

A specific training course with simulation techniques improves knowledge and teamwork with a high team satisfaction rate. Likewise, it reduces the response time during a vital emergency.

1. Van Herzeele I, Sevdalis N, Lachat M, Desender L, Rudarakanchana N, Rancic Z. Team training in ruptured EVAR [Internet]. Vol. 55, Journal of Cardiovascular Surgery. 2014 [cited 2020 Jan 21]. p. 193-206. Available from: https://www.minervamedica.it/en/journals/cardiovascular-surgery/article.php?cod=R37Y2014N02A0193 2. Mayer. Logistic considerations for a successful institutional approach to the endovascular repair of ruptured abdominal aortic aneurysms. Vascular. 2010;18(2):64-70. 3. Aho P, Vikatmaa L, Niemi-Murola L, Venermo M. Simulation training streamlines the real-life performance in endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg [Internet]. 2019 Jun [cited 2019 Nov 20];69(6):1758-65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30497858