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TissueDB/Simulators/Resuscitative Endovascular Balloon Occlusion of the Aorta Simulator (Keller)

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The Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Simulator (Keller) is a high-cost REBOA trainer. Keller 2016 built it around a commercial pulsatile blood pump rather than from locally available materials.[1] It is for practising percutaneous femoral access, Seldinger conversion, and 12 French sheath upsizing. It is also for practising CODA balloon deployment and Zone 1 and Zone 3 occlusion identification.

Field Details
Features and Basic Operation The trainer provides pulsatile pressure waves for REBOA practice. The learner practises percutaneous or ultrasound-guided femoral access, sheath placement and REBOA balloon deployment using a commercial torso trainer. Interchangeable groin molds support percutaneous and cut-down access with gelatin, or deployment-only practice with a sheath already placed in foam. The gelatin mold serves up to four deployments before replacement; the foam mold supports repeated deployments during a training session. External torso landmarks guide Zone 1 and Zone 3 placement. Arterial monitors display the proximal pressure rise and loss of distal pressure when the balloon is inflated.
Current Development Status Bench-tested for hemodynamic performance; not yet validated for skill acquisition or retention.[1]
Estimated Build Time and Cost
<US$11,000
Specialized Tools and Equipment Pulsatile blood pump (Harvard Apparatus Model #1423). Two arterial pressure transducers (Edwards Lifesciences). Invasive blood pressure monitors (Welch Allyn). An ultrasound machine for ultrasound-guided access on the gelatin mold. Three-way stopcocks for circuit priming.
Version Version 1
Development Team Contact Information University of California Davis Medical Center, Department of Surgery (lead: Benjamin A. Keller, MD, bakeller@ucdavis.edu); David Grant USAF Medical Center, Departments of Vascular and Endovascular Surgery and General Surgery; UC Davis Department of Biomedical Engineering; UC Davis Medical Center, Department of Pathology and Laboratory Medicine.

Tissues

Tissue Qty Material Cost Notes
Abdominal aorta 1 segment Latex tubing — Made out of a 2.5-cm inner diameter (ID) latex tubing. Length not specified in source.
Common iliac arteries 2 segments (right and left) Latex tubing — Joined with polymer connectors at branches/bifurcations and size transitions made out of 1.3-cm ID latex tubing.
Common femoral arteries 2 segments (right and left) Latex tubing — Right common femoral artery for arterial access. Left common femoral artery for distal pressure monitoring and the take-off for the pump-return branch.
Skin (combined groin soft tissue) 1 mold Gelatin — Ultrasound-compatible gelatin femoral access mold simulating combined groin soft tissue (skin, fat and muscle); supports percutaneous and cut-down access; replaced after four deployments (Keller et al. 2016).
Adult simulated torso1Adult torso mannequin (Laerdal Medical)—Houses the entire vascular circuit and access molds. Allows external palpation for xyphoid (Zone 1) and umbilicus (Zone 3) landmarks. In the source, the 60th Medical Group Simulation Center provided it. Many institutions already own a Laerdal adult torso.

Structural Parts

Part Name Qty Material Cost Notes
Pulsatile perfusion pump1Harvard Apparatus Model #1423US$9,879Commercial pulsatile blood pump designed for large-animal perfusion and hemodynamic studies. The stroke volume and pump rate are adjustable, to recreate clinical scenarios such as hypotensive trauma.
Latex pump-return tubing1 segmentLatex tubing—Branches off the left common femoral artery and returns to the perfusion pump.
PVC pump inflow/outflow tubing—Polyvinyl chloride tubing—The pump inflow and outflow are made of 1.3-cm ID polyvinyl chloride tubing.
Polymer connectorsSeveral (count not specified in source)Polymer (brand not specified in source)—Allow transitions between different size tubing and branches/bifurcations within the circuit.
One-way check valve1Brand not specified in source—Installed in the return tubing to prevent retrograde flow.
Proximal circuit shunt1Brand not specified in source—A one-way check valve in the return tubing and a proximal circuit shunt prevents retrograde flow within the circuit and shunts antegrade flow during periods of occlusion respectively.
Three-way stopcocksSeveral (count not specified in source)Brand not specified in source—Used for priming the circuit with water and purging air.
Arterial pressure transducers2Edwards Lifesciences—One in the proximal aorta, one in the left common femoral artery.
Invasive blood pressure monitors1 or moreWelch Allyn—Provide real-time arterial waveform tracings, so the user can verify proximal against distal pressure. Many institutions already own these.
Foam femoral access mold (interchangeable, deployment-only)1 moldFoam (type not specified in source)—Foam mold with the 12 Fr Cook Medical sheath already in place for deployment-only practice. It serves an unlimited number of deployments per session. The foam type is not specified.
Gelatin femoral access mold (interchangeable, ultrasound-compatible)1 moldGelatin—Ultrasound-compatible; transduces discernible pulsations. Supports percutaneous and cut-down access. Replace after four deployments.

Consumables

Consumable Quantity Material Approximate Cost Notes
Arterial access catheter1 per attemptTeleflex-Arrow—For initial percutaneous puncture of the right common femoral artery.
Guidewire (0.035-inch Amplatz)1 per attemptBoston Scientific—For Seldinger conversion from the arterial catheter to the sheath.
Introducer sheath1 per attemptCook Medical, 12 Fr—Catheter access route for balloon deployment. Pre-placed in the foam mold; inserted per attempt with the gelatin mold.
CODA balloon catheter1 per attemptCook Medical, 12 Fr 32-mm—Aortic occlusion balloon. On inflation, proximal (central aortic) pressure rises while distal pressure falls. The main recurring consumable.

Build Instructions

The source describes the finished design rather than a step-by-step build, so the phase order below is a reconstruction. The source does not give segment lengths, the gelatin or foam mold fabrication method, or the order of priming versus transducer installation (the three-way stopcocks must be in place before priming, since the circuit is primed through them).

Phase 1: Cut the vascular circuit

  1. Cut a length of 2.5 cm inner diameter (ID) latex tubing for the abdominal aorta segment.
  2. Cut four lengths of 1.3 cm ID latex tubing for the right and left common iliac and right and left common femoral artery segments. Source verbatim: "The abdominal aorta was made out of a 2.5-cm inner diameter (ID) latex tubing, and the iliac and femoral arteries were made out of 1.3-cm ID latex tubing."

Phase 2: Connectors and bifurcation

  1. Join the segments with polymer connectors at the branches/bifurcations and size transitions.

Phase 3: Return tubing and check valve

  1. Branch additional latex tubing off the left common femoral artery and route it back to the perfusion pump.
  2. Install a one-way check valve in the return tubing to prevent retrograde flow.

Phase 4: Proximal shunt

  1. Install a proximal circuit shunt to shunt antegrade flow during balloon occlusion.

Phase 5: Pump tubing

  1. Connect the pump inflow and outflow using 1.3 cm ID polyvinyl chloride (PVC) tubing.

Phase 6: Femoral access molds

  1. Construct the ultrasound-compatible gelatin femoral access mold (supports percutaneous and cut-down access). The source does not specify the mold-fabrication method.
  2. Construct the foam femoral access mold with the 12 Fr Cook Medical sheath pre-placed.

Phase 7: Torso integration

  1. Place the entire vascular circuit and access molds inside the Laerdal Medical adult simulated torso, oriented so the xyphoid (Zone 1 landmark) and umbilicus (Zone 3 landmark) are externally palpable.

Phase 8: Prime and purge

  1. Prime the circuit with water and purge air through the integrated three-way stopcocks.

Phase 9: Pressure transducers and monitors

  1. Install one Edwards Lifesciences arterial pressure transducer in the proximal aorta and one in the left common femoral artery; connect each to a Welch Allyn invasive blood pressure monitor.

Phase 10: Pump connection and tuning

  1. Connect the Harvard Apparatus Model #1423 pulsatile pump; set the stroke volume and rate to the desired clinical scenario (for example, hypotensive trauma).

Phase 11: Verify the hemodynamic envelope (bench test)

  1. Confirm cardiac output 1.7 to 6.8 L/min, systolic blood pressure 54 to 226 mmHg, diastolic blood pressure 14 to 121 mmHg, and heart rate 30 to 80 bpm.

Phase 12: Verify the deployment response (bench test)

  1. Perform a test REBOA deployment via the right common femoral artery (gelatin or foam mold per scenario): percutaneous puncture with a Teleflex-Arrow arterial catheter; confirm placement by pulsatile flow and ultrasound; Seldinger conversion with a 0.035-inch Boston Scientific Amplatz wire; upsize to a 12 Fr Cook Medical sheath; advance a 12 Fr 32-mm Cook Medical CODA balloon catheter to the target zone; inflate the balloon.
  2. Confirm anatomic placement by lifting the simulated torso and palpating the inflated balloon within the aorta.
  3. Confirm the therapeutic response: proximal systolic blood pressure rises 10 to 62 mmHg, the distal arterial waveform dampens, and distal systolic blood pressure drops to 0 mmHg.

For training scenarios (Zone 1 versus Zone 3 deployment, hypotensive-trauma simulation, two-mold workflow comparison), see the corresponding SELF Module for REBOA training scenarios.

References

  1. ↑ 1.0 1.1 Keller BA, Salcedo ES, Williams TK, Neff LP, Carden AJ, Li Y, Gotlib O, Tran NK, Galante JM. Design of a cost-effective, hemodynamically adjustable model for resuscitative endovascular balloon occlusion of the aorta (REBOA) simulation. J Trauma Acute Care Surg. 2016 Sep;81(3):606–611. DOI: 10.1097/TA.0000000000001153. PMID: 27270855.
Simulator data
Alternative names Pulsatile REBOA Simulator


Page data
Keywords REBOA, resuscitative endovascular balloon occlusion of the aorta, aortic occlusion, CODA balloon, femoral arterial access, Seldinger technique, trauma simulation, vascular trainer, pulsatile perfusion
Authors Arturopelayo
License CC-BY-SA-4.0
Language English (en)
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Redirects TissueDB/Simulators/Keller REBOA Trainer, TissueDB/Simulators/Pulsatile REBOA Simulator, TissueDB/Simulators/UC Davis REBOA Trainer, TissueDB/Simulators/Pulsatile REBOA Simulator (Keller)
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Created May 2, 2026 by Arturo Pelayo
Last edit October 3, 2026 by Arturo Pelayo
Cite as Arturopelayo (2026). "TissueDB/Simulators/Resuscitative Endovascular Balloon Occlusion of the Aorta Simulator (Keller)". Appropedia. Retrieved October 3, 2026.
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