| Résumé | Background: Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths are potentially salvageable with damage control surgery (DCS). As recent innovations in informatic technology allow for remote specialist-support to point-of-care providers, advanced interventions, such as DCS, may be possible in remote settings. Methods: An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the “Cut-suit”) was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated-blood (fluid) during 6 stages: incision, retraction, direction, identification, packing and post-packing. Six fully credentialed surgeons performed the same task as 12 military medical technicians (MT) who were randomized to unmentored (n = 5) (UMT) or remotely telementored (n = 7) (RTM) real-time guidance by a trauma surgeon. Results: There were no significant differences in fluid loss between the surgeons and the UMT group. However, when comparing surgeons to the RTM group, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014) and packing (p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM used more sponges than surgeons and significantly more than UMT (p = 0.048). However, mentoring significantly increased non-surgeon procedural confidence (p = 0.004). Conclusion: Perihepatic packing of an exsanguinating liver hemorrhage was performed by military medical technicians after a focused briefing. While real-time RTM did not reduce the surrogate outcome of fluid loss in this model, it significantly increased non-surgeon procedural confidence, which may increase the feasibility of the concept. |
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