The Development of a Trauma Interventional Radiology Alert Protocol Reduces Time to Vessel Puncture in Cases of Active Hemorrhage

Introduction Trauma continues to be a major cause of death in the United States, with uncontrolled bleeding contributing to a significant portion of trauma-related fatalities. In recent years, the management of hemorrhagic trauma patients has expanded to include interventional radiology (IR). The American College of Surgeons Committee on Trauma recommends that Level 1 and 2 trauma centers ensure IR availability within 60 minutes of the decision to proceed with angiography. Delays in IR intervention are associated with poorer outcomes and increased mortality. To address this, our Level 2 trauma center developed and implemented an institutional protocol involving trauma surgeons, interventional radiologists, residents, trauma advanced practice providers, ED staff, and IR nursing teams to reduce time to intervention for trauma patients with uncontrolled hemorrhage. Methods On March 1, 2023, a new institutional protocol was launched to expedite IR intervention in trauma patients with hemorrhage. When such a patient is identified, the trauma team leader (TTL) directly contacts an IR physician to review imaging and determine the need for urgent endovascular therapy. If IR intervention is agreed upon, the TTL places a STAT IR consult, which marks the start time for time tracking. This time period ends when an IR physician achieves vascular access. To accelerate intervention, the TTL informs the primary nurse of the protocol activation, and a trauma vascular IR (VIR) alert is sent via Vocera^®. The primary nurse and VIR charge nurse coordinate room availability, prepare the patient for transport, and ready the IR suite. Results Data were collected prospectively after protocol implementation (beginning March 2023) and retrospectively for the period starting January 2022. The pre-protocol cohort included 11 patients, and the post-protocol cohort included 12 patients. Comparison of the two groups showed a significant reduction in mean consult-to-needle time: 102 minutes ± 39.5 pre-protocol vs. 48.2 minutes ± 12.7 post-protocol (p < 0.001). Conclusions Timely VIR intervention is essential for effective hemorrhage control in trauma patients. Transitioning a patient from the trauma bay to the IR suite requires seamless coordination across multiple teams, and delays can negatively impact outcomes. Establishing a standardized institutional protocol can reduce time to intervention by streamlining workflows and minimizing communication-related delays. While our study is limited by a small sample size, ongoing data collection is expected to further support these initial findings.