Hybrid Trauma and Endovascular Surgery
Applied
Type
ModificationConfidence
95%
Created
Mar 26, 2026
Evidence
2 sources
Rationale
The section was updated to integrate specific findings from the UK-REBOA trial and the Castellini meta-analysis. While these studies were already mentioned, adding specific statistical outcomes (90-day mortality, OR, CI) and the number of studies in the meta-analysis strengthens the evidence base. A critical distinction was made between the ED setting of the UK-REBOA trial and the Hybrid OR environment, which is the primary focus of this section. Abbreviations were expanded on first use as per the instructions.
Evidence
Content Changes
removedadded
<!-- type: treatment --> Hybrid trauma and endovascular surgery integrates **open damage control surgery** with **immediate angiography/endovascular control**, minimizing time lost to transfers and enabling physiology-driven sequencing (control hemorrhage first, then definitive repair). [@trauma2016-endovascular] [@rutherford2018-rutherford] **Why hybrid matters in endovascular trauma management (EVTM)** - Enables **simultaneous** laparotomy/thoracotomy with resuscitative endovascular balloon occlusion of the aorta (REBOA) management, embolization, and covered stent deployment. - Reduces “handoff delays” for unstable patients who cannot tolerate transport to interventional radiology (IR). - Supports iterative damage control: packing/temporary closure → angioembolization → reassessment → staged definitive repair. [@wses2018] While REBOA is a core component of the EVTM toolkit, recent high-quality evidence has introduced important caveats.caveats regarding its application. The UK-REBOA randomized clinical trial (RCT)(RCT), which evaluated REBOA in the emergency department (ED) setting, found that the addition of REBOA to standard care in patients with exsanguinating hemorrhage actually increased 90-day mortality (54% vs 42%),42%; suggestingodds thatratio its[OR] use1.58, 95% CI 0.98-2.53) [@jansen2026-emergency-emergency]. This suggests that REBOA may be harmful in certain emergency departmentED settings or patient populationspopulations, [@jansen2026-emergency].potentially due to procedural delays or complications. Furthermore, meta-analysesa indicatesystematic review and meta-analysis of 28 studies indicates that survival benefits associated with REBOA remain inconsistent,inconsistent across the literature, highlighting the need for rigorous patient selection and specialized team training within the hybrid environment [@castellini2021].[@castellini2021-resuscitative]. <!-- type: comparison --> **Table 16.5. Location of Care for Unstable Hemorrhage (Practical Framework)** | **Setting** | **Best for** | **Limitations** | | --- | --- | --- | | **Hybrid OR** | Unstable noncompressible torso hemorrhage (NCTH) needing possible laparotomy + endovascular control | Resource-intensive; requires trained team | | **IR suite** | Stable or transient responders needing embolization | Transport risk; limited access to open surgery | | **Standard OR** | Rapid laparotomy/packing when no endovascular capability | Delayed pelvic/branch arterial control | **Pelvic hemorrhage integration** Hybrid capability is particularly valuable for pelvic fracture hemorrhage where pathways commonly combine binder/preperitoneal pelvic packing (PPP), selective REBOA (Zone III), and angioembolization depending on physiology and resource timing. [@coccolini2017-wses] [@bulger2019] [@castellini2021][@castellini2021-resuscitative] See also: [[Pelvic Trauma Hemorrhage]] and [[Vascular Trauma|Ch. 15]].