EVTM in Resuscitation Workflows

in Endovascular Trauma Management

Applied

Type

Modification

Confidence

90%

Created

Mar 27, 2026

Evidence

2 sources

Rationale

The integration updates the resuscitation workflow with the most recent European guidelines (Rossaint 2023), which replace/supplement the previous 2019 version. This ensures geographic balance between US (Bulger/SVS) and European (Rossaint/ESVS) recommendations. Additionally, the Cralley 2026 registry data provides a critical clinical comparison between REBOA and resuscitative thoracotomy, which is a key decision point in the 'Bridge maneuver' phase of the workflow. Abbreviations were expanded as per instructions.

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. 2023;158(3):231-239. 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 + DCR | Early massive transfusion pathway; prevent hypothermia; correct coagulopathy.coagulopathy using damage control resuscitation (DCR) principles. [@spahn2019] [@rossaint2023-c] |
| 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.exists; in Zone I, REBOA may serve as an alternative to resuscitative thoracotomy (RT) in patients with signs of life. [@bulger2019] [@cralley2026-e] |
| 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] [@rossaint2023-c] |

**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-c]

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