The key to answering this question is to look at the resources that a hybrid OR brings to bear, and then determine what types of patients can take full advantage of them. Sadly, we have no guidance from the trauma literature, so we need to let our imaginations run free.

The basic concept for hybrid room use is this:

“My patient needs interventional radiology plus at least one other surgical specialty procedure”

The additional procedures don’t necessarily need to benefit from or utilize the IR capabilities. But they do need to be of an emergent nature. For example, a patient with a pelvic fracture can undergo angio-embolization and pelvic external fixation, while the gynecologic surgeons repair a vaginal laceration. Simultaneous, but not related to the embolization.

Here’s my list of possibilities. It is by no means complete or exhaustive. It’s just a start. All include the interventional radiologist for some part of it:

• Pelvic fractures with angioembolization plus:
  • Preperitoneal packing
  • Perineal / gynecologic repair
  • Laparotomy
• Liver angioembolization plus laparotomy
• Thoracic aortic injury plus laparotomy
• Angiographic assistance for management of vascular extremity injury
• Any of the previous procedures plus craniotomy*
• And don’t forget to toss REBOA in with this!
• Plus some other stuff I’m sure you will think up

Tomorrow, some details to think about while setting up your own hybrid OR!