Endovascular resuscitation and trauma management in the hybrid emergency room system: Ideal solution for surgical, endovascular and radiological trinity

The concept of endovascular resuscitation and trauma management (EVTM) refers to endovascular techniques for resuscitation, hemorrhage control, and definitive trauma management. The use of EVTM or computed tomogra-phy (CT) imaging is still limited in hemodynamically unstable patients. The hybrid emergency room system (HERS) is a suitable context to facilitate EVTM. The HERS consists of an operating table with a C-arm and a sliding CT scanner system in the resuscitation area, allowing emergency diagnostic and therapeutic interventions without relocating the patient. The primary purpose of this study was to present the feasibility and assess the potential for the successful implementation of HERS. The second aim was to reduce concerns on the validity of this context and the third was to lay a foundation for planned intervention studies in EVTM and HERS. In the HERS environ-ment, endovascular treatment will be performed in the resuscitation room, which expands the indications of endovascular treatment to include hemodynamically unstable patients. HERS can also reduce the logistic burden and thus provide time to identify injuries with CT. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable adjunct treatment for refractory hemorrhagic shock but its procedure-related complications must be considered. In the HERS environment, REBOA can be performed more safely, rapidly, and accurately with fluoroscopy, followed by immediate definitive hemostasis without relocation. In addition, HERS may safely extend the application of REBOA-CT to identify accurate injury sites. HERS may be an ideal EVTM solution for the trinity of surgery, endovascular treatment, and imaging in trauma care. We will continue to explore the most radical and safest EVTM in the HERS environment.