EVTM in Resuscitation Workflows

in Endovascular Trauma Management

Applied

Type

Modification

Confidence

95%

Created

Mar 26, 2026

Evidence

1 source

Rationale

The section was updated to include the 6th edition of the European guideline on major bleeding and coagulopathy (Rossaint et al., 2023), which replaces the previous 2019 version (Spahn et al.). This ensures the textbook reflects the most current international consensus. Additionally, the abbreviation DCR was expanded on first use per instructions, and geographic balance was maintained by pairing the US-based ACS-COT guidelines with the updated European guidelines for REBOA usage.

Evidence

Rossaint R, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80. PMID: 36859355.

Verified source

PubMed DOI

Content Changes

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**Table 16.2. Endovascular trauma management (EVTM) Resuscitation Workflow (Physiology-First, Time-to-Control)** [@trauma2016-endovascular]

| **Phase** | **Action** | **Operational detail** |
| --- | --- | --- |
| Arrival | Activate trauma + DCRdamage control resuscitation (DCR) | Early massive transfusion pathway; prevent hypothermia; correct coagulopathy. [@spahn2019][@rossaint2023-european] |
| Arrival | Obtain access | Femoral arterial + venous access early when noncompressible torso hemorrhage (NCTH) is possible. [@bulger2019] |
| Unstable + suspected NCTH | Bridge maneuver | resuscitative endovascular balloon occlusion of the aorta (REBOA) (Zone I or III) only if a rapid path to definitive control exists. [@bulger2019] [@rossaint2023-european] |
| Transient responder | Rapid imaging | computed tomography angiography (CTA) when hemodynamics allow to localize bleeding and plan endovascular vs open. |
| Definitive hemorrhage control | Endovascular | Embolization for pelvic/solid organ bleeding; covered stent for junctional arterial disruption. [@coccolini2017-wses] [@markov2011] |
| Definitive hemorrhage control | Open + endovascular | Hybrid OR: laparotomy/packing + angio/embolization/stent as needed. [@wses2018] |
| Post-control | Transition to critical care | Occlusion deflation plan, metabolic management, limb/renal monitoring; staged definitive repair as physiology normalizes. [@bulger2019] |

**Key workflow rule**

REBOA and other EVTM tools are **not definitive therapy**; they are time-buying interventions that must shorten the interval to hemostasis, not prolong it. [@bulger2019] [@morrison2014]

Cross-reference: [[Damage Control Surgery]] and [[Massive Transfusion]]. [@spahn2019][@rossaint2023-european]

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