Role of a Hybrid Room in Damage Control Surgery

  • Dushyant Iyer
  • Chad G. Ball
  • Scott K. D’Amours


Time to hemorrhage control is the key performance indicator of a trauma system. Open and percutaneous techniques represent complementary therapeutic modalities that may both be necessary in achieving expedient hemorrhage control. In most trauma facilities, the operating theater and angiography suite are separate rooms, not infrequently located on different floors or buildings. Transfer between these locations increases time to hemorrhage control and the chances of a patient succumbing to physiological exhaustion. By unifying an operating theater and angiography suite, hybrid rooms offer the potential to minimize time to hemorrhage control through nullifying the dilemma of deciding the optimal location to best manage a patient’s ongoing bleeding.


Hybrid suite Hybrid room RAPTOR Hemorrhage control Damage control surgery Damage control resuscitation 


  1. 1.
    Champion HR, Bellamy RF, Roberts CP, Leppaniemi A. A profile of combat injury. J Trauma. 2003;54:S13–9.PubMedGoogle Scholar
  2. 2.
    Soreide K, Kruger AJ, Vardal AL, Ellingsen CL, Soreide E, Lossius HM. Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace, older face. World J Surg. 2007;31:2092–103.CrossRefPubMedGoogle Scholar
  3. 3.
    Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149:55–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg. 2000;190:288–98.CrossRefPubMedGoogle Scholar
  5. 5.
    Howell GM, Peitzman AB, Nirula R, Rosengart MR, Alarcon LH, Billiar TR, et al. Delay to therapeutic interventional radiology postinjury: time is of the essence. J Trauma. 2010;68:1296–300.CrossRefPubMedGoogle Scholar
  6. 6.
    Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008;65:748–54.CrossRefPubMedGoogle Scholar
  7. 7.
    MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55:39–44.CrossRefPubMedGoogle Scholar
  8. 8.
    Papakostidis C, Kanakaris N, Dimitriou R, Giannoudis PV. The role of arterial embolization in controlling pelvic fracture hemorrhage: a systematic review of the literature. Eur J Radiol. 2012;81:897–904.CrossRefPubMedGoogle Scholar
  9. 9.
    Schnuriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma. 2011;70:252–60.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee WA, Matsumura JS, Mitchell RS, Farber MA, Greenberg RK, Azizzadeh A, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg. 2011;53:187–92.CrossRefPubMedGoogle Scholar
  11. 11.
    Hamill J, Holden A, Paice R, Civil I. Pelvic fracture pattern predicts pelvic arterial hemorrhage. Aust N Z J Surg. 2000;70:338–43.CrossRefPubMedGoogle Scholar
  12. 12.
    Ertel W, Keel M, Eid K, Platz A, Trentz O. Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma. 2001;15:468–74.CrossRefPubMedGoogle Scholar
  13. 13.
    Eastridge BJ, Starr A, Minei JP, O'Keefe GE, Scalea TM. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53:446–50; discussion 50–1.CrossRefPubMedGoogle Scholar
  14. 14.
    Tai DK, Li WH, Lee KY, Cheng M, Lee KB, Tang LF, et al. Retroperitoneal pelvic packing in the management of hemodynamically unstable pelvic fractures: a level I trauma center experience. J Trauma. 2011;71:E79–86.CrossRefPubMedGoogle Scholar
  15. 15.
    Thorson CM, Ryan ML, Otero CA, Vu T, Borja MJ, Jose J, et al. Operating room or angiography suite for hemodynamically unstable pelvic fractures? J Trauma Acute Care Surg. 2012;72:364–70; discussion 71–2.CrossRefPubMedGoogle Scholar
  16. 16.
    Hauschild O, Aghayev E, von Heyden J, Strohm PC, Culemann U, Pohlemann T, et al. Angioembolization for pelvic hemorrhage control: results from the German pelvic injury register. J Trauma Acute Care Surg. 2012;73:679–84.CrossRefPubMedGoogle Scholar
  17. 17.
    Fehr A, Beveridge J, D’Amours SD, Kirkpatrick AW, Ball CG. The potential benefit of a hybrid operating environment among severely injured patients with persistent hemorrhage: how often could we get it right? J Trauma Acute Care Surg. 2016;80:457–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Kirkpatrick AW, Vis C, Dube M, Biesbroek S, Ball CG, Laberge J, et al. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (resuscitation with angiography percutaneous treatments and operative resuscitations). Injury. 2014;45:1413–21.CrossRefPubMedGoogle Scholar
  19. 19.
    Holcomb JB, Fox EE, Scalea TM, Napolitano LM, Albarado R, Gill B, et al. Current opinion on catheter-based hemorrhage control in trauma patients. J Trauma Acute Care Surg. 2014;76:888–93.CrossRefPubMedGoogle Scholar
  20. 20.
    Griswold RA, Drye JC. Cardiac wounds. Ann Surg. 1954;139:783–5.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Martin M, Izenberg S, Cole F, Bergstrom S, Long W. A decade of experience with a selective policy for direct to operating room trauma resuscitations. Am J Surg. 2012;204:187–92.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dushyant Iyer
    • 1
  • Chad G. Ball
    • 2
    • 3
  • Scott K. D’Amours
    • 4
  1. 1.Department of Trauma Surgery, Liverpool HospitalThe University of New South WalesSydneyAustralia
  2. 2.Department of Hepatobiliary and Pancreatic SurgeryUniversity of CalgaryCalgaryCanada
  3. 3.Department of Trauma and Acute Care SurgeryUniversity of CalgaryCalgaryCanada
  4. 4.Department of Trauma Surgery and General Surgery, Liverpool HospitalUniversity of New South WalesSydneyAustralia

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