Joint statement outlines faster endovascular bleeding control in trauma care

The American College of Surgeons (ACS) Committee on Trauma and the Society of Interventional Radiology (SIR) have issued a joint position statement reaffirming the role of interventional radiologists on multidisciplinary trauma teams and the importance of establishing reliable systems for rapid endovascular hemorrhage control in trauma situations.

The joint-position statement, "Rapid Endovascular Hemorrhage Control in Trauma," outlines how trauma programs can speed access to hemorrhage-stopping embolization through earlier consultation, shared decision-making and coordinated activation of the full care team. Uncontrolled bleeding is a leading cause of trauma death.

For a patient in hemorrhagic shock, every step between recognizing the bleeding and achieving definitive control matters. Trauma centers need processes that bring trauma surgeons and interventional radiologists together early, mobilize the full team in parallel and get the right patient to treatment without avoidable delay."

Luke R. Wilkins, MD, FSIR, the statement's lead author and interventional radiologist, University of Virginia Health System

"This statement reinforces that the fastest path to hemorrhage control begins with early communication and a shared plan," said Jon Perlstein, MD, FACS, chair of trauma and acute care surgery at Sutter Health/Sutter Roseville Medical Center and a co-author of the statement. "By integrating interventional radiology into trauma workflows from the outset, teams can match each patient with the most appropriate treatment, coordinate operative and endovascular care when both are needed, and reduce delays to definitive bleeding control."

The statement clarifies the intent of ACS Standard 4.15, which requires Level I and Level II trauma centers to maintain the personnel and facilities needed to begin an endovascular or interventional radiology procedure for hemorrhage control within 60 minutes when the patient's clinical condition requires rapid intervention. It also provided the following guidance for operationalizing the standard:

• Engage interventional radiology early to support rapid, shared decisions about the most appropriate method of hemorrhage control.
• Prioritize patients most likely to benefit from rapid angioembolization, such as patients who are hemodynamically unstable or require transfusion.
• Create a standardized activation pathway that defines who initiates consultation, who can activate the pathway and how the angiography suite, anesthesia, transport, nursing and technologist teams are mobilized.
• Establish protocols to support parallel workflows for patients who need both endovascular and operative interventions. 
• Measure decision-to-puncture time, along with other milestones that reveal workflow bottlenecks.
• Use continuous performance improvement tools, such as multidisciplinary debriefings, process mapping, staff education and review of delays, to strengthen readiness and sustain reliable response times.

"This joint statement gives trauma centers a shared, practical framework for bringing surgical and endovascular expertise together when every minute matters," said Saher S. Sabri, MD, FSIR, president of the Society of Interventional Radiology. "Aligning trauma teams around early collaboration, system readiness and continuous improvement can reduce avoidable delays and deliver the most appropriate lifesaving care for each injured patient."

"Rapid hemorrhage control depends on a trauma system that is prepared to bring the right expertise and resources to the patient without delay," said Avery Nathens, MD, PhD, FACS, medical director of the ACS Trauma Quality Programs, and senior author of the statement. "This joint statement translates that shared commitment into practical guidance that can strengthen collaboration, improve readiness and help trauma teams deliver timely, definitive care to patients with life-threatening bleeding."

The statement appears online in the Journal of Vascular and Interventional Radiology and the Journal of the American College of Surgeons.