EVTM 2018 Symposium Documentation

Access all sessions from the 2:nd EVTM Symposium 2018.

Opening session EVTM round table 2018:
– Endovascular Resuscitation current update – T. Rasmussen (US)
– When do truncal hemorrhage patients die and what are we going to do about it – L. Moore (US)
– Experience from EVAR in rAAA- adjunct techniques that can be used in bleeding patients- T. Larzon (SE)
– Lessons learned from clinical experience and training perspectives over the last 5 years – M. Brenner (US)
– Updates on open techniques for hemorrhage control – Role of Endo? Future? Changes in DSTC courses? – K. Boffard (ZA)
– Optimizing endovascular resuscitation for trauma management : A senior trauma surgeon’s perspective – EE. Moore (US)
– First successful REBOA in mass casualty event and other experience at Role 2 MTF – V. Reva (RU)
– Introducing a Trauma Hybrid OR to your trauma service – A. Kirkpatrick (CA)
– Round table discussion 1: EVTM; Endovascular resuscitation and REBOA – Where do we stand? Where do we go?

Session 1: EVTM practical issues and multidisciplinary approach
– REBOA in South Africa- update and short term lessons – is it really needed? – F. Plani (ZA)
– IR/endovascular role in bleeding control – How to do? How to think? Examples – M. Delle (SE)
– Multidisciplinary early bleeding control interventions in Japan. Who? How? Updates – J. Matsumoto & Y. Matsamura (JP)
– Using endo (and hybrid) techniques in trauma – Evidence? Guidelines? Trauma surgeon thoughts – L. Handolin (FI)
– Endovascular techniques and imaging in bleeding patients – J. Matsumoto (JP)
– Practical aspects of EVTM implementation at your institution – What ”stuff” do you need? – M. Hoehn (US)
– Effect of EVTM with the Hybrid ER: Innovation in the field of severe trauma – T. Kinoshita (JP)
– Is Multidisciplinary/EVTM concept applicable in the US? Who should do what? – J. Duchesne (US)
– Debate 2.0: EVTM in my hospital – Yes, we do! – B. Kessel & O. Galili (IL)
– Debate 2.0: EVTM in my hospital – Dream on; Impossible! – G. Oosthuizen (ZA)
– Panel and audience discussion

Session 2: Vascular access in resuscitation, bleeding & trauma patients
– When and for whom should we obtain emergent femoral vascular access on arrival? – T. Williams (US)
– Vascular access in austere environment/on site/battlefield. Update/tips/problems – V. Reva (RU)
– How to close a vascular access? Closure devices – What to use, when? – Z. Rancic (CH)
– Vascular access for non-vascular surgeons/non IR; Feasible? How to learn? Tips? – Y. Matsumura (JP)
– What to use for access in the ER/Surgery/IR suite for access? New devices? Complications – D. Eefting (NL)
– PRO- vascular access on arrival/in the field – We should do it in selected cases – V. Reva (RU)
– Debate 2.0: CON-Vascular access on arrival/in the field- Dangerous; Bad idea! – L. Moore (US)
– Panel and audience discussion

Session 3: Updates on REBOA
– Never do REBOA for chest or CNS injuries? True or myth? – T. Williams (US)
– Should I start in Zone 1 first for every REBOA use? What can I use to confirm position now and in the near future? – E. Benjamin (US)
– Never do REBOA – existing data and contra-indications – J. Duchesne (US)
– Practical aspects of REBOA – Who do you need? What kind of team? Imaging? – M. Hoehn (US)
– Why pREBOA and iREBOA? What does the data tell us? – L. Neff (US)
– On the horizon for vascular access and REBOA – T. Rasmussen (US)
– Clinical trials update – The ABOTrauma registry update – D. McGreevy (SE)
– Clinical trials update – The AORTA study (US) – J. DuBose (US)
– Clinical trials update – The DIRECT IABO study (JP) – Y. Matsamura (JP)
– Israeli experience with REBOA. For trauma and non-trauma: two years experience – B. Kessel (IL) & G. Shaked (IL)
– Panel and audience discussion

Session 4: Zone III REBOA embolization and pelvic bleeders
– Walkthrough of the new pelvic fracture guidelines (Packing/embolization/REBOA) – F. Coccolini (IT)
– Transitioning to a practice using zone 3 for REBOA – practical aspects and tips – J. Ibrahim (US)
– Level 2-3 trauma REBOA – can you manipulate the ”golden hour”? – W. Teeter (US)
– What to do when things go wrong and it ́s bleeding? Cases – J. Tisnado (US)
– Liquid embolisation for the pelvic – data and how to do – A M. Lerardi (IT)
– EVTM and REBOA for pediatric patients – A bridge to far? – L. Neff (US)
– Debate 2.0: PRO- REBOA should always be considered for pelvic bleeders – M. Brenner (US)
– Debate 2.0: CON- REBOA only if pre-peritoneal packing fails – S. Cacala & G. Oosthuizen (ZA)
– Panel and audience discussion

Session 5: Training aspects of endo-resuscitation and residents point of view!
7 min talk + 3 min discussion. Chairs: Megan Brenner and Artai Pirouzram

– The way to do it – Vascular surgeon or interventional radiologist – M. Taudorf (DK)
– REBOA by EM physicians: US perspective and challenges – W. Teeter (US)
– Military aspects of EVTM training and what is relevant in my experience. Training my residents? – M. Martin (US)
– EndoVascular Training and group for advanced endo treatment in trauma (Korean first experience) – S. Chang (KR)
– Radial Artery Access for Angioembolization in Trauma and training aspects – J. DuBose (US)
– Training Courses in the USA – What’s on the horizon and what is needed? To who? – M. Brenner (US) & M. Hoehn (US)
– Debate 2.0: We have to do EVTM/REBOA – K. Mani (Vascular) (SE)
– Debate 2.0: No, We should do EVTM/REBOA – J. Galante (Trauma) (US)
– Panel and audience discussion on training aspects for EVTM – Who should do what?

Session 6: Pre-hospital and military REBOA and EVTM techniques
7 min talk + 3 min discussion
Chairs: Joe DuBose and Viktor Reva
– Military EVTM experience. Data! US military update – M. Northern (US)
– En route transfer REBOA on the battlefield – J. Keränen & L. Handolin (FI)
– REBOA vs alternative minimally invasive techniques for massive pelvic hemorrhage on the battlefield – M. Martin (US)
– ”Beating Heart” vs. ”Non-Beating Heart” Traumatic Cardiac Arrest: Implications for Resuscitation – J. Manning (US)
– Civilian pre-hospital REBOA: update current status and where do we go? – S. Sadek (UK)
– Civilan pre-hospital REBOA: update Japan, possibilities and limitations? -Y. Matsamura (JP)
– Implementing the REBOA-protocol for non-vascular trauma surgeons – F. Plani & G. Oosthuizen (ZA)
– Pre-hospital femoral access and REBOA use might become part of standard combat casualty care capability in the near future, realistic? – L. Neff (US)
– REBOA afloat- an adjunct to military maritime damage control resuscitation and surgery – P. Rees (UK)
– Debate 2.0: PRO: Transfer vascular access and REBOA – is there a role for that in EVTM? Advantages and considerations YES – J. Galante (US)
– Debate 2.0: CON: Transfer vascular access and REBOA – is there a role for that in EVTM? Disadvantages and considerations Don’t – L. Moore (US)
11.50 Round tables discussion 2: On pre-hospital and military EVTM/REBOA and EVTM methods in the field – what is possible? Should we push the limits?

– Mentice lunch satellite symposium – LIVE Patient Simulation – REBOA, team, complication and process management – Experienced ideas on how to setup an effective training program. With Megan Brenner & Lars Lönn

Session 7: Endovascular and hybrid techniques for bleeding control. Chairs: Megan Brenner and Thomas Larzon.
– Sizing endografts for younger patients (Thorax, Abdomen, Iliac, Subclavian) – S. Spiliopoulos (GR)
– Onyx and mechanical embolic agents for bleeding control. Any rationale? – A M. Lerardi (IT)
– Animal SAAP models and REBOA data. Where do we go? – J. Ross (US)
– TEVAR in trauma and bleeders – L. Qingsheng (CN)
– Liver bleeding – how to manage; What to use in visceral bleeding? Optimal imaging? Tips – M. Delle (DE)
– Subclavian, axillary and neck vessels – Technical aspects to hemostasis in the EVTM era – J. Duschene (US)
– Debate: You have to have endografts for EVTM! What every major hospital should have on its shelf – K. Mani (SE)
– Debate: Simple C-arm and some simple tools can make a different. What to use and what to have on the shelf (Europe) – A. Priouzram & T. Hörer (SE)
– Live debate ”what to have in my EVTM kit” and how to use it.

Session 8: More on training and who should do EVTM – We want to do that! Chairs: Joe DuBose and George Oosthuizen.
– Training for fast vascular access – How fast, what is safe? What to consider and how to teach? – D. Eefting (NL)
– The great panel debate: Trauma surgeons vs Emergency doctors v.s Vascular surgeons vs Interventional Radiologists.
How should we use EVTM and when? Training.
– Simulation and working with C Arm – What exist and what can be done? – L. Lönn (DK)
– Perfused models – What exist and what can be done? How to get a good model? Limitations? – E. Benjamin (US)
– Training modalities in EVTM. What’s out there. Benefits and limitations – T. Williams (US)
– Resuscitative balloon occlusion of the aorta (REBOA): a population based analysis of potential trauma patients in Germany – K. Elias (DE)
– Debate 2.0: PRO – With proper training, anyone can do REBOA (and other procedures?) – J. Ibrahim (US)
– Debate 2.0: CON – EVTM and REBOA procedures should be done by professionals! – C-M. Wahlgren & C Montan (SE)
– Panel and audience discussion

Session 9: Vascular injuries EVTM treatment – open and endo; visceral bleeding. Chairs: Todd Rasmussen and Carl M Wahlgren.
– Choosing embolization agent – What, when and how? My favorite tools – R. Lopez (CH)
– Vascular injuries in South Africa-data? Place for Endo? – G. Oosthuizen (ZA)
– Vascular injuries in Brazil-data? First Brazilian EVTM workshop rapport – J. Sahagoff, M. Steinman & B. Pereira (BR)
– Isolated Aortic Abdominal Injury in Blunt Trauma: Two Case Reports and Review of the Literature – B. Raguan (IL)
– More on vascular injuries and strategies. How to do, what to consider? – S. Spiliopoulos (GR)
– Vessels endograft repair for trauma beyond the thoracic aorta – current data & results – US data – J. DuBose (US)
– Choosing embolization agent – What, when and how? These are my favorite tools! – M. Delle (SE)
– TEVAR – The solution for Thoracic Aortic Blunt and Penetrating Trauma- Guidelines and Indications – S. Fajer (IL)

Session 10: Endovascular Resuscitation; What do we know? Translational data and research. Chairs: Boris Kessel and Jim Manning.
– REBOA (ABO) might be used for non-trauma cases – The physiology behind it and why it works?! REBOA should be in eCPR! – K. Nilsson (SE)
– Indications for REBOA and embolization in PPH – when/how? – E. Søvik (NO)
– Retrievable Stents as an Alternative to REBOA for Aortic and Caval Hemorrhage – B. Tillman (US)
– How hybrid trauma management might change ”classic surgery”? Role in cancer surgery? – B. Kessel (IL)
– Thoracic injuries and intra-opeartive use of REBOA. Experience from Colombia – Ordoñez (CO)
– Cardiac arrest and REBOA – myth or reality? Bridge to ECMO? – A. Johnson (US)
– Debate 2.0: PRO – REBOA has a role in hemodynamic unstable patients, not only trauma! – F. Plani (ZA)
– Debate 2.0: CON – REBOA is dangerous and has no place in other bleeders! – J. Duchesne (US)

Session 11: Complications, anesthesiological and ICU aspects 1 Chairs: Joe DuBose and Lauri Handolin.
– What complications to expect after endovascular procedure? How to manage it? ICU aspects – P. Skoog (SE)
– What can we learn on the ICU period in REBOA treated patients? Day 2-3-4? – L. Moore (US)
– Endovascular major complications – How to avoid and how to solve. Post-operative considerations – T. Larzon (SE)
– REBOA during CPR – experience/data – Is it effective? Any data? – E. Dogan (SE)
– A new femoral access for REBOA and ECPR by a hybrid technique – L. Lamhaut (FR)
– A place for balloons in the ICU? Endovascular approaches for profound shock states – A. Johnson (US)
– Simulation for aortic occlusion balloon in RAAA – a protocol including all hybrid staff reduces door-to-balloon time – A. Albäck (FI)
– Round tables discussion 3: Where do we stand and how to avoid complications? Optimal ICU care? Role of ICU staff?

Session 12: Complications, anesthisiological and ICU aspects 2; Medical treatment and other adjuncts in bleeding? Chairs: Boris Kessel and Laura Moore.
– Pressure, flow and inflammation: managing the patient undergoing balloon occlusion aorta – S. Kellet (UK)
– Intra-abdominal hypertension and abdominal compartment syndrome in bleeders – Lessons – Z. Rancic (CH)
– ECMO – possible role for Endovascular Resuscitation; When? Who? – M. Larsson (SE)
– ECMO in Endovascular Resuscitation. Data and let’s speculate – L. Lamhaut (FR)
– Antithrombotic treatment in the ICU after EVTM. You have an endograft in. What to do next? Evidence? – P. Skoog (SE)
– Imaging: CT, angio and hybrid suite or semi-hybrid suites – what ́s out there and what’s on the horizon? – M. Taudorf & L. Lönn (DK)
– Debate: Supraceliac hematoma and severe hypotension at trauma laparotomy: left thoracotomy and X-clamp vs. REBOA?
ICU care is way different! – K. Boffard (ZA)
– Debate: Supraceliac hematoma and severe hypotension at trauma laparotomy: left thoracotomy and X-clamp vs. REBOA?
ICU care is quite the same – M. Martin (US)
– Panel and audience discussion
– Update on the JEVTM. Where do we go? – J. DuBose (US)
– EVTM Future aspects, the next EVTM symposium, JEVTM, the EVTM society and closing remarks – T. Hörer (SE)