RAPTOR suite

Reviewed and revised 11 July 2014

OVERVIEW

• The RAPTOR suite is hybrid unit designed for both interventional radiology and operative interventions
• RAPTOR is acronym for ‘Resuscitation with angiography, percutaneous techniques and operative repair’
• overcomes the drawbacks of many traditional angio suites that are not designed for anaesthesia or interventions in unstable patients

DESCRIPTION

• a dedicated location where percutaneous trauma procedures, interventional and diagnostic radiology, including computed tomography (CT), open operative techniques and resuscitation, can be concurrently performed
• Percutaneous trauma procedures include interventions:
  (1) aimed at arresting haemorrhage (e.g. intravascular balloon dilation/occlusion with or without arterial embolization), and
  (2) urgent interventions aimed to repair damaged vessels (e.g. stent grafting)
• selection of patients for management within hybrid suites is typically based on haemodynamic and/or physiologic instability but is most suited to those who the preferred strategy is unclear

ADVANTAGES

• potential to minimize delay to expedient haemorrhage control by providing integrated operating, CT and angiographic facilities in a single location
• reduced decision-making time (no destination choices to make)
• no time lost in transit between two venues should one technique fail
• less risk of complications from transport and transfer
• capacity to provide ongoing resuscitation while obtaining imaging
• retrospective studies suggest that delay to radiographic vascular occlusion or laparotomy in trauma patients is associated with increased mortality

DISADVANTAGES

• convincing outcome data showing benefit of RAPTOR suites is currently lacking
• controversy over which staff should be involved (should trauma surgeons perform emergent IR procedures?)
• high setup and running costs
• emphasis on hemorrhage control and timely care means patients may be admitted to the hybrid suite with the clinicians knowing little information about specific injuries and less obvious injuries may not be detected initially
• little evidence to guide triage (inappropriate patient selection may increase resource strain or alternatively exclude appropriate patients from life-saving care)
• precise formal classification of haemodynamic instability is difficult
• requires multi-disciplinary consultant input to ensure appropriate resource use and interventions, requiring extensive ‘after-hours’ attendance and call
• team leadership and composition may be dynamic depending on whether patients bypass the ED
• training requirements remain incompletely defined
• availability likely to be limited only to major, high volume centers with well developed trauma systems
•  extensive equipment required and maintenance
• complex workplace ergonomics
• sustainability, efficiency and cost-effectiveness  is uncertain

EXAMPLE

• An early adopter of a dedicated trauma hybrid or RAPTOR suite in Australasia is Liverpool Hospital in Sydney.

References and Links

Journal articles

• Ball CG, Kirkpatrick AW, D’Amours SK. The RAPTOR: Resuscitation with angiography, percutaneous techniques and operative repair. Transforming the discipline of trauma surgery. Can J Surg. 2011 Oct;54(5):E3-4. PubMed PMID: 21933518; PubMed Central PMCID: PMC3195651.
• D’Amours SK, Rastogi P, Ball CG. Utility of simultaneous interventional radiology and operative surgery in a dedicated suite for seriously injured patients. Curr Opin Crit Care. 2013 Dec;19(6):587-93. doi: 10.1097/MCC.0000000000000031. PubMed PMID: 24240824.
• Kirkpatrick AW, Vis C, Dubé M, Biesbroek S, Ball CG, Laberge J, Shultz J, Rea K, Sadler D, Holcomb JB, Kortbeek J. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: The RAPTOR (resuscitation with angiography percutaneous treatments and operative resuscitations). Injury. 2014 Jan 31. pii: S0020-1383(14)00047-3. doi: 10.1016/j.injury.2014.01.021. [Epub ahead of print] PubMed PMID: 24560091.

FOAM and web resources

• ScanCrit — RAPTOR suite (2013)