Endovascular and Extracorporeal Management of Complex Traumatic Injuries: Emerging Technologies and Techniques

Management of prehospital hemorrhagic shock and traumatic cardiac arrest remains a critical capability gap in trauma resuscitation. Hybrid endovascular and extracorporeal technologies and techniques are evolving to meet the challenges of noncompressible hemorrhage, tissue perfusion, gas exchange, and metabolic derangement correction in the setting of complex traumatic injuries and aim to improve patient outcomes by augmenting the capabilities of interdisciplinary trauma/critical care resuscitation teams. The clinical value of these emerging technological advancements depends upon matching the intervention(s) to the dominant physiological failure modes while assisting in damage control surgery and definitive surgical repair. This narrative review discusses advancements in resuscitative endovascular balloon occlusion of the aorta (REBOA) and inferior vena cava (REBOVC), selective regional perfusion, and extracorporeal membrane oxygenation (ECMO), and the technical and logistical barriers facing their clinical implementation. An escalating care pathway and conceptual framework to manage noncompressible hemorrhage and hemorrhage-induced traumatic cardiac arrest utilizing an integrated endovascular and extracorporeal approach is proposed based on prior literature and recent developments in selective abdominopelvic perfusion. Market dynamics remain an important consideration for fielding new technologies; development of specialized medical devices would benefit from versatile, multi-use capabilities to serve broader patient populations to enable economically sustainable employment within healthcare systems.