Endovascular resuscitation – the Emergency Physician has a key role to play

Abstract

Endovascular resuscitative techniques in the critically hemorrhaging or otherwise ill patient are evolving at a phenomenal pace. One can review the articles appearing on a monthly to month basis in journals like this and others to see evidence of this.   From the onset, there has been much debate about who would and should be best placed to do procedures such as REBOA or ECMO. Is it primarily the domain of the surgeon, and if so the trauma surgeon, cardiothoracic surgeon, or vascular surgeon? Should the surgeons defer to the interventional radiologist?   These arguments miss a very important point – the reality is that effective management of these critically ill and injured patients requires a collaborative team approach. Everyone involved, from the emergency physician to the intensivist, interventionalist, and surgeon, not to mention our nursing and paramedical colleagues, have “skin in the game” as we say in the United States. The goal of this team sport is clearly reaching the appropriate endpoint of restoration of normal physiology, be it by stopping bleeding or restoring circulation.