TissueDB/Simulators/Resuscitative Endovascular Balloon Occlusion of the Aorta Simulator (Keller)
General Information
The Pulsatile REBOA Simulator (Keller) is a low-cost, hemodynamically adjustable simulator for resuscitative endovascular balloon occlusion of the aorta, developed by Keller and colleagues at the University of California Davis Medical Center and David Grant USAF Medical Center in 2016.[1] The simulator pairs a five-segment latex and polyvinyl chloride vascular circuit with a commercially available pulsatile pump to recreate physiologic cardiac output (1.7 to 6.8 L/min) and arterial pressure waveforms, allowing trainees to practise percutaneous femoral access, Seldinger conversion, sheath upsize to 12 Fr, CODA balloon deployment, and palpation-confirmed zone identification on a Laerdal adult simulated torso.
| Field | Details |
|---|---|
| General Information | Hemodynamically adjustable, low-cost pulsatile REBOA simulator (Keller et al. 2016, J Trauma Acute Care Surg 81(3):606–611, DOI 10.1097/TA.0000000000001153).[1] Five-segment vascular circuit (abdominal aorta, common iliac arteries, common femoral arteries, pump return) constructed from latex and polyvinyl chloride tubing, housed in a Laerdal adult simulated torso for palpation-based zone identification. Two interchangeable femoral access molds (gelatin and foam) support either full percutaneous practice or pre-sheathed deployment-only practice. |
| Features and Basic Operation | Pulsatile pressure-wave generation: cardiac output 1.7 to 6.8 L/min; systolic blood pressure 54 to 226 mmHg; diastolic blood pressure 14 to 121 mmHg; heart rate 30 to 80 bpm.[1] Real-time proximal aortic and distal femoral arterial waveform display via Welch Allyn invasive monitors. Two interchangeable femoral access molds: gelatin (ultrasound-compatible, full percutaneous practice, reusable up to four deployments) and foam (12 Fr sheath pre-placed, deployment-only practice, unlimited reuse per session). Zone 1 deployment at xyphoid landmark; Zone 3 deployment at umbilicus landmark. Therapeutic response observable: proximal systolic blood pressure rises by 10 to 62 mmHg on balloon inflation; distal systolic blood pressure drops to 0 mmHg.[1] |
| Current Development Status | First pass clinical |
| Estimated Build Time and Cost | Under US$11,000 (2016 USD; approximately US$15,071 in 2026 USD via FRED CPIAUCNS factor 1.3701, June 2016 to March 2026) |
| Specialized Tools and Equipment | Pulsatile blood pump (Harvard Apparatus Model #1423); two arterial pressure transducers (Edwards Lifesciences); invasive blood pressure monitors (Welch Allyn); ultrasound system (compatible with the gelatin mold); three-way stopcocks for circuit priming.[1] |
| Version | 2016 (Keller et al., J Trauma Acute Care Surg 81(3):606–611) |
| Development Team Contact Information | University of California Davis Medical Center, Department of Surgery (lead: Benjamin A. Keller, MD); 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.[1] |
Validation Status
The Pulsatile REBOA Simulator is bench-validated for hemodynamic performance: cardiac output 1.7 to 6.8 L/min, systolic blood pressure 54 to 226 mmHg, diastolic blood pressure 14 to 121 mmHg, heart rate 30 to 80 bpm, and a balloon-inflation therapeutic systolic response of 10 to 62 mmHg.[1] The simulator was used at one UC Davis Medical Center trauma and vascular surgery workshop before clinical adoption.[1]
The simulator has not been validated for skill acquisition or retention. The authors stated at time of publication: "the pulsatile simulator has not been validated in terms of skill acquisition and retention; however, validation studies are being planned" (Keller 2016 page 611).[1] No follow-on validation study has been published as of 12 May 2026 (PubMed query for Keller BA combined with REBOA and simulation returned only the original 2016 publication).
Tissues
| Tissue | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Abdominal aorta | 1 segment, 2.5 cm inner diameter, length sized to fit the simulated torso[1] | Latex tubing | (included in <US$1,121 total tubing/molds/torso/monitors/connectors — 2016 USD; <US$1,536 in 2026 USD via FRED CPIAUCNS factor 1.3701) | Constructed from 2.5 cm inner diameter latex tubing.[1] Source verbatim: "The abdominal aorta was made out of a 2.5-cm inner diameter (ID) latex tubing". |
| Common iliac arteries | 2 segments, 1.3 cm inner diameter (right and left), connected to the abdominal aorta via polymer connectors at the iliac bifurcation[1] | Latex tubing | (included in <US$1,121 total — 2016 USD) | Source verbatim: "the iliac and femoral arteries were made out of 1.3-cm ID latex tubing".[1] |
| Common femoral arteries | 2 segments, 1.3 cm inner diameter (right and left), connected to the common iliac arteries[1] | Latex tubing | (included in <US$1,121 total — 2016 USD) | Right common femoral artery is used for arterial access; left common femoral artery is used for distal pressure monitoring.[1] |
| Pump return tubing | 1 segment, 1.3 cm inner diameter, branches off the left common femoral artery and returns to the perfusion pump[1] | Polyvinyl chloride tubing | (included in <US$1,121 total — 2016 USD) | Source verbatim: "The pump inflow and outflow are made of 1.3-cm ID polyvinyl chloride tubing".[1] Includes a one-way check valve in the return tubing and a proximal circuit shunt to divert antegrade flow during balloon occlusion. |
| Femoral access mold (gelatin variant) | 1 mold, reusable up to four deployments before replacement[1] | Gelatin (ultrasound-compatible) | (included in <US$1,121 total — 2016 USD; replacement cost minor, labour-dominated) | Ultrasound-compatible gelatin mold transducing discernible pulsations. Used for full percutaneous access practice (needle puncture, Seldinger conversion, sheath upsize, balloon deployment).[1] |
| Femoral access mold (foam variant) | 1 mold with 12 Fr Cook Medical sheath pre-placed; unlimited reuse per session[1] | Foam (type not specified in source) | (included in <US$1,121 total — 2016 USD) | Foam mold with 12 Fr Cook Medical sheath already in place. Used for deployment-only practice (skip the access step; focus on catheter manipulation and balloon inflation). Note: the source paper says "foam mold" without specifying foam type. Builders may substitute any closed-cell foam capable of holding a 12 Fr sheath in place; EVA Foam is one accessible option, not a Keller specification.[1] |
Structural Parts
| Part Name | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Pulsatile perfusion pump (commercial: Harvard Apparatus pulsatile pump for large-animal perfusion) | 1 | Harvard Apparatus Model #1423 (Cambridge, MA, USA) | US$9,879 (2016 USD; approximately US$13,535 in 2026 USD via FRED CPIAUCNS factor 1.3701) | Designed for large animal perfusion and hemodynamic studies. Stroke volume and pump rate adjustable to recreate clinical scenarios such as hypotensive trauma.[1] |
| Polymer connectors | several | Generic | (included in <US$1,121 total — 2016 USD) | Allow transitions between different size tubing and branches/bifurcations within the circuit.[1] |
| One-way check valve | 1 | Generic | (included in <US$1,121 total — 2016 USD) | Installed in the return tubing to prevent retrograde flow.[1] |
| Three-way stopcocks | several | Generic | (included in <US$1,121 total — 2016 USD) | Used for priming the circuit with water and purging air.[1] |
| Arterial pressure transducers | 2 | Edwards Lifesciences (Irvine, CA, USA) | (included in <US$1,121 total — 2016 USD) | One in the proximal aorta, one in the left femoral artery.[1] |
| Invasive blood pressure monitors | 1+ | Welch Allyn (Skaneateles Falls, NY, USA) | (included in <US$1,121 total — 2016 USD; many sites already own institutional monitors) | Provide real-time arterial waveform tracings for proximal-versus-distal pressure verification.[1] |
| Adult simulated torso | 1 | Laerdal Medical (Stavanger Norway) | (included in <US$1,121 total — 2016 USD; many institutions already own a Laerdal adult torso for other simulation work) | Houses the entire vascular circuit and access molds. Allows external palpation for xyphoid (Zone 1) and umbilicus (Zone 3) landmark identification.[1] |
Consumables
| Consumable | Quantity | Material | Approximate Cost | Notes |
|---|---|---|---|---|
| Arterial access catheter | 1 per attempt (gelatin mold) | Teleflex-Arrow (Limerick, PA, USA) | Per-attempt cost not itemised in source documentation | For initial percutaneous puncture of the right common femoral artery.[1] |
| Guidewire (0.035-inch / 0.89 mm Amplatz) | 1 per attempt (gelatin mold) | Boston Scientific (Marlborough, MA, USA) | Per-attempt cost not itemised in source documentation | For Seldinger conversion from arterial catheter to sheath.[1] |
| Introducer sheath | 1 per gelatin-mold session, or pre-placed in foam mold | Cook Medical, 12 Fr (Bloomington, IN, USA) | Per-attempt cost not itemised in source documentation | Catheter access route for balloon deployment.[1] |
| CODA balloon catheter | 1 per attempt (consumable; primary recurring cost) | Cook Medical, 12 Fr 32-mm (Bloomington, IN, USA) | Per-attempt cost not itemised in source documentation | Aortic occlusion balloon. Inflate to occlude flow distal to the balloon, redirecting central pressure to heart and brain.[1] |
Build Instructions
Phase 1: Vascular circuit cut
- Cut a length of 2.5 cm inner diameter (ID) latex tubing for the abdominal aorta segment.[1]
- 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 from Keller 2016 page 2 column 1: "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."[1]
Phase 2: Connectors and bifurcation
- Connect the segments using polymer connectors at the iliac bifurcation and at the femoral take-offs.[1]
Phase 3: Return tubing and check valve
- Branch additional latex tubing off the left common femoral artery and route it to the perfusion pump.[1]
- Install a one-way check valve in the return tubing to prevent retrograde flow.[1]
Phase 4: Proximal shunt
- Install a proximal circuit shunt to divert antegrade flow during balloon occlusion.[1]
Phase 5: Pump tubing
- Connect pump inflow and outflow using 1.3 cm ID polyvinyl chloride (PVC) tubing.[1]
Phase 6: Femoral access molds
- Construct the gelatin femoral access mold (ultrasound-compatible).[1]
- Construct the foam femoral access mold with the 12 Fr Cook Medical sheath pre-placed.[1]
Phase 7: Torso integration
- 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.[1]
Phase 8: Prime and purge
- Prime the circuit with water and purge air through the integrated three-way stopcocks.[1]
Phase 9: Pressure transducers and monitors
- 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.[1]
Phase 10: Pump connection and tuning
- Connect the Harvard Apparatus Model #1423 pulsatile pump; set stroke volume and rate to the desired clinical scenario (for example, hypotensive trauma).[1]
Phase 11: Verify hemodynamic envelope (bench test)
- 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.[1]
Phase 12: Verify deployment response (bench test)
- Perform a test REBOA deployment via the right common femoral artery (gelatin mold 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 (0.89 mm) 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.[1]
- Confirm anatomic placement by lifting the simulated torso and palpating the inflated balloon within the aorta.[1]
- Confirm therapeutic response: proximal systolic blood pressure rises 10 to 62 mmHg, distal arterial waveform dampens, and distal systolic blood pressure drops to 0 mmHg.[1]
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 (in development; not yet a TissueDB page).
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 1.39 1.40 1.41 1.42 1.43 1.44 1.45 1.46 1.47 1.48 1.49 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.
| Alternative names | Pulsatile REBOA Simulator Keller Pulsatile REBOA Simulator UC Davis REBOA Trainer Keller REBOA Trainer |
|---|
| Authors | Arturopelayo |
|---|---|
| License | CC-BY-SA-4.0 |
| Cite as | Arturopelayo (2026). "TissueDB/Simulators/Resuscitative Endovascular Balloon Occlusion of the Aorta Simulator (Keller)". Appropedia. Retrieved June 4, 2026. |