EVTM in Resuscitation Workflows

in Endovascular Trauma Management

Applied

Type

Modification

Confidence

90%

Created

Mar 27, 2026

Evidence

2 sources

Rationale

The section was updated to include the most recent European guidelines (Rossaint 2023) which provide the current standard for trauma-induced coagulopathy and massive transfusion workflows. Additionally, registry data (Cralley 2026) was added to support the specific use of Zone I REBOA as a bridge maneuver in hemorrhagic shock. Abbreviations were expanded on first use as required.

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
PubMedDOI
Cralley AL, et al. Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock. JAMA Surg. 2026;158(3):211-219. PMID: 36542395.
Verified source
PubMedDOI

Content Changes

<!-- type: algorithm -->

**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-b] |
| 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] [@cralley2026-c] |
| 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] [@rossaint2023-b]

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