Rapid Response to Traumatic Vascular Injury: An Institutional Code Angio Protocol

Traumatic vascular injuries are a major cause of death and disability, especially in those under 45. Vascular and interventional radiology (VIR) has transformed management, offering minimally invasive options. This paper examines the implementation of a Code Angio protocol at a level I trauma center to expedite response times for such injuries by VIR. Initiated in August 2014 at University Hospital in San Antonio, Code Angio uses automated alerts to simultaneously notify a multidisciplinary team-including VIR, trauma surgery, anesthesia, and operating room staff-when trauma patients meet vascular injury criteria. After implementation, Code Angio response times decreased, and the need for urgent laparotomies for hemorrhage control was reduced. From 2019 to 2024, 1,447 cases were recorded, with Code Angio facilitating rapid VIR team activation, mostly within 60 minutes. The survival rate for Code Angio patients was higher than with surgery alone. Subgroup analysis showed Code Angio's routine use in specific injuries, helping reduce invasive surgeries and optimizing resource use. Rapid response VIR protocols like Code Angio improve patient outcomes, resource use, and healthcare efficiency. Future efforts will focus on better integration with trauma guidelines, identifying workflow delays, and continuous protocol refinement for seamless coordination.