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INTRODUCTION/BACKGROUND (HYBRID ROOM, HYBRID TEAM)

Historically, open surgery was the only choice available to manage noncompressible torso hemorrhage (NCTH), junctional hemorrhage, or other vascular injuries. In the past few decades, we have witnessed the evolution of endovascular and hybrid surgical methods, allowing a paradigm shift in the diagnosis and treatment of vascular-related diseases and bleeding patients. These methods are today being used on a daily basis by vascular, trauma, and general surgeons as well as interventional radiologists, with the entire vascular tree amenable to percutaneous interventions. Minimally invasive endovascular surgery has developed quickly and in some situations, replaces open surgery with good results (e.g., in the treatment of blunt aortic injuries). One major aim in using endovascular and hybrid methods for bleeding control is not only the potential for decreasing mortality but also minimizing morbidity and complications.1–3

The clinical application of endovascular and hybrid surgical methods was initially developed by vascular surgeons from the use of aortic occlusion balloons for ruptured aortic aneurysms. However, it has now expanded to the use of endografts, embolization, and other endovascular and hybrid tools and it is now being used more frequently in trauma care, specifically in vascular injuries.4–6 These treatment modalities have been gathered into a concept named EndoVascular resuscitation and Trauma Management (EVTM), focusing on the use of endovascular and hybrid open surgical methods for resuscitation, hemorrhage control, and definitive management of both trauma and nontrauma patients.7–10

The fact that hemorrhage is the leading cause of potentially preventable trauma death not only applies to pre-hospital care but equally to in-hospital management. According to the concept of Advanced Trauma Life Support (ATLS), as part of the initial assessment of a hypotensive blunt trauma injury patient in the emergency department extended Focused Assessment with Sonography for Trauma (eFAST) is mainly used to identify the need and area for surgical intervention. However, the demand for better and more accurate diagnostics is becoming more and more frequent, especially with the increased use of EVTM. It is now recognized that the relocation of patients to and from the radiology or interventional suite for diagnostic imaging using computed tomography (CT) or angiography significantly delays definitive management and hemorrhage control. It has been shown that for every 3 minute delay to the operating room (OR), the probability of death increases by 1%.11 Additionally, these interventional suites are seldom in close proximity to one another and in many places angiography interventions can be delayed significantly while waiting for the team to prepare the room. The availability of hybrid angiography suites has increased but they are not always available 24/7 and in many places there is a time delay due to lack of in-house personnel. The involvement of separate teams in another location and requiring patient transfer might cause an additional patient safety issue and delay of treatment.

Considering that 70% of emergency angiographies occur in “off-hours” with less than ...

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