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Narrative Review Article

The Endovascular resuscitation and Trauma Management (EVTM) in the Hybrid Emergency Room System (HERS)

Ideal solution for Surgical, Endovascular and Radiological Trinity

  • Yosuke Matsumura Chiba University Graduate School of Medicine
  • Junichi Matsumoto Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine
  • Kaori Ito Department of Emergency Medicine, Division of Acute Care Surgery, Teikyo University School of Medicine
  • Hiroyuki Ohbe Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine
  • Takahiro Kinoshita Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
  • Kei Hayashida Department of Emergency and Critical Care Medicine, School of Medicine, Keio University
  • Tomohiro Funabiki Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital
  • Kazuma Yamakawa Division of Trauma and Surgical Critical Care, Osaka General Medical Centre
  • Shigeki Kushimoto Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine
  • Satoshi Fujimi Division of Trauma and Surgical Critical Care, Osaka General Medical Centre

Abstract

The concept of EndoVascular resuscitation and Trauma Management (EVTM) has recently been proposed to refer to the use of endovascular techniques for resuscitation, haemorrhage control, and definitive trauma management. Although the popularity of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been growing, the use of the EVTM or CT imaging is still limited in hemodynamically unstable patients. To overcome the current limitations, the Hybrid Emergency Room System (HERS) was introduced in 2011. HERS consists of an operating table with an angiographic C-arm and a sliding CT scanner system in the resuscitation area, which allows all emergency diagnostic and therapeutic interventions without relocating the patient. This paper deals with current limitations of EVTM and proposes solutions with HERS.


In the HERS environment, patients can undergo IR in the resuscitation room, which may expand the indications of IR to include hemodynamically unstable patients. HERS can also reduce CT scanning time to identify unexpected injuries or traumatic brain injury. It also allows prompt neurosurgical intervention simultaneously with haemorrhage control. REBOA is a viable adjunct treatment for refractory haemorrhagic shock but its procedure-related complications must be considered. REBOA can be performed more safely, rapidly, and accurately in HERS, followed by immediate definitive haemostasis. In addition, HERS may safely extend the application of REBOA-CT to identify accurate injury site.


HERS may be an ideal EVTM solution for the trinity of surgery, endovascular treatment, and imaging in trauma care. We will continue to explore the most radical and safest EVTM in the HERS environment.

Published

2019-01-31

How to Cite

MATSUMURA, Yosuke et al. The Endovascular resuscitation and Trauma Management (EVTM) in the Hybrid Emergency Room System (HERS). Journal of Endovascular Resuscitation and Trauma Management, [S.l.], v. 3, n. 1, jan. 2019. ISSN 2002-7567. Available at: <http://journal.jevtm.com/index.php/jevtm/article/view/80>. Date accessed: 25 aug. 2019. doi: https://doi.org/10.26676/jevtm.v3i1.80.

Section

Narrative Review Article