Hybrid Trauma and Endovascular Surgery
Type
AdditionConfidence
72%
Created
Mar 28, 2026
Evidence
2 sources
Rationale
Article 1 (Guan 2026, PMID 37653766) is directly relevant: it reviews REBOA-specific complications and prevention strategies, which complements the existing paragraph on REBOA caveats and supports the hybrid team's need for structured complication management. A sentence was added to the REBOA paragraph to capture this practical safety dimension. Article 3 (Walsh 2024, PMID 39200824) addresses futility markers and time-outs during massive transfusion — a clinically meaningful concept for hybrid trauma teams who must decide when to cease resuscitation; a brief bullet was added under the 'Why hybrid matters' list to acknowledge this. Article 2 (Latif 2023, PMID 37226264) was flagged and scored only 50/100; it covers general traumatic hemorrhage chain-of-survival concepts that are not specific enough to this section's focus on hybrid OR integration to warrant inclusion without human review, so it was excluded.
Evidence
Content Changes
<!-- 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"handoff delays”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] - Requires structured protocols for recognizing futility and timely transition to comfort-focused care when resuscitation is unlikely to succeed [@walsh2024]. While REBOA is a core component of the EVTM toolkit, recent high-quality evidence has introduced important caveats. The UK-REBOA randomized clinical trial (RCT) found that the addition of REBOA to standard care in patients with exsanguinating hemorrhage actually increased mortality (54% vs 42%), suggesting that its use may be harmful in certain emergency department settings or patient populations [@jansen2026-emergency]. Furthermore, meta-analyses indicate that survival benefits associated with REBOA remain inconsistent, highlighting the need for rigorous patient selection and specialized team training within the hybrid environment [@castellini2021]. Awareness of REBOA-specific complications — including access-site thrombosis, limb ischemia, aortic injury, and balloon malposition — is essential for teams operating in the hybrid environment; structured prevention strategies and post-deployment monitoring protocols are recommended to mitigate these risks [@guan2026]. <!-- 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] See also: [[Pelvic Trauma Hemorrhage]] and [[Vascular Trauma|Ch. 15]].