Interventional Radiology in Trauma Resuscitation
1Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Japan
Interventional radiology (IR) is classified as conservative treatment (i.e., nonoperative management). However, IR is also used for aggressive hemostatic treatment in emergency situations. Trauma IR is a type of emergency IR, but it differs from conventional (nontrauma) emergency IR in several ways. First, in some trauma cases, there are multiple sources of bleeding, whereas in nontrauma emergencies, such as postoperative bleeding and gastrointestinal bleeding, the bleeding usually comes from one source. Second, in many cases, trauma induces coagulopathy, but coagulopathy is rarely present in nontrauma emergency cases. Third, trauma may entail multiple injuries, and so the amount of time spent on treatment for each injury is limited.
For trauma IR to be effective as treatment, it must be performed immediately as needed, like trauma surgery. There are two ways to ensure that this is done; one is that a radiologist is always available in a hospital; the second is the establishment of an on-call system that guarantees that the radiologist will be at the trauma unit when a patient is transferred there. In many cases, IR may not be necessary. Even if trauma IR is not necessary, trauma surgeons will perform some imaging studies, such as chest radiography, pelvic radiography, focused assessment with sonography for trauma, or computed tomography. The information from these studies is important, therefore radiologists should interpret them on site. If the radiologist’s workload causes difficulty with such a system, trauma surgeons should be trained by radiologists to interpret trauma images and to perform IR including elective IR. And then they will be able to perform trauma IR as well.