Damage control resuscitation: REBOA as the new fourth pillar

Carlos A Ordoñez; Michael W Parra; José Julián Serna; Fernando Rodríguez-Holguin; Alberto García; Alexander Salcedo; Yaset Caicedo; Natalia Padilla; Luis Fernando Pino; Adolfo González Hadad; Mario Alain Herrera; Mauricio Millán; Laureano Quintero-Barrera; Fabian Hernández-Medina; Ricardo Ferrada; Megan Brenner; Todd Rasmussen; Thomas Scalea; Rao Ivatury; John B Holcomb

doi:10.25100/cm.v51i4.4353

Damage control resuscitation: REBOA as the new fourth pillar

Colomb Med (Cali). 2020 Dec 30;51(4):e4014353. doi: 10.25100/cm.v51i4.4353.

Authors

Carlos A Ordoñez^{1

2

3}, Michael W Parra⁴, José Julián Serna^{1

2

3

5}, Fernando Rodríguez-Holguin¹, Alberto García^{1

2

3}, Alexander Salcedo^{1

2

3}, Yaset Caicedo⁶, Natalia Padilla⁶, Luis Fernando Pino^{2

5}, Adolfo González Hadad^{2

5

7}, Mario Alain Herrera^{2

5}, Mauricio Millán^{3

8}, Laureano Quintero-Barrera^{2

7}, Fabian Hernández-Medina^{2

5}, Ricardo Ferrada^{2

7}, Megan Brenner⁹, Todd Rasmussen¹⁰, Thomas Scalea¹¹, Rao Ivatury¹², John B Holcomb¹³

Affiliations

¹ Fundación Valle del Lili. Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.
² Universidad del Valle, Facultad de Salud, Escuela de Medicina. Cali, Colombia.
³ Universidad Icesi, Cali, Colombia.
⁴ Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA.
⁵ Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.
⁶ Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia.
⁷ Centro Médico Imbanaco, Cali, Colombia.
⁸ Fundación Valle del Lili, Division of Transplant Surgery, Department of Surgery, Cali, Colombia.
⁹ University of California, Department of Surgery Riverside University Health Systems . Riverside , CA , USA.
¹⁰ Uniformed Services University, F. Edward Hebert School of Medicine, Department of Surgery, Bethesda, Maryland. USA.
¹¹ University of Maryland, Department of Surgery, School of Medicine, Baltimore, MD USA.
¹² Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA.
¹³ University of Alabama Center for Injury Science, Department of Surgery, Birmingham. AL, USA.

Abstract
in English, Spanish

Damage Control Resuscitation (DCR) seeks to combat metabolic decompensation of the severely injured trauma patient by battling on three major fronts: Permissive Hypotension, Hemostatic Resuscitation, and Damage Control Surgery (DCS). The aim of this article is to perform a review of the history of DCR/DCS and to propose a new paradigm that has emerged from the recent advancements in endovascular technology: The Resuscitative Balloon Occlusion of the Aorta (REBOA). Thanks to the advances in technology, a bridge has been created between Pre-hospital Management and the Control of Bleeding described in Stage I of DCS which is the inclusion and placement of a REBOA. We have been able to show that REBOA is not only a tool that aids in the control of hemorrhage, it is also a vital tool in the hemodynamic resuscitation of a severely injured blunt and/or penetrating trauma patient. That is why we propose a new paradigm "The Fourth Pillar": Permissive Hypotension, Hemostatic Resuscitation, Damage Control Surgery and REBOA.

La resucitación en control de daños busca combatir la descompensación metabólica del paciente severamente traumatizado mediante tres ejes: la hipotensión permisiva, la resucitación hemostática y la cirugía de control de daños. El objetivo de este artículo es hacer una revisión de la historia de la resucitación en control de daños y la cirugía de control de daños proponiendo un nuevo paradigma basado en los recientes avances de la tecnología endovascular. Un puente ha sido creado entre el manejo prehospitalario y el control del sangrado, descrito antes de la etapa I de la cirugía de control de daños, que es la inclusión y colocación de un REBOA. Esta es una herramienta adicional en el control de la hemorragia y de soporte en la resucitación hemodinámica de los pacientes con trauma severo de tipo cerrado y/o penetrante. Por lo que se propone un nuevo paradigma “El cuarto pilar”: Hipotensión permisiva, resucitación hemostática, cirugía de control de daños y REBOA.

Keywords: Damage Control Resuscitation; Hemorrhage; REBOA; Shock.

Publication types

Review

MeSH terms

Aorta*
Balloon Occlusion*
Endovascular Procedures*
Humans
Hypotension, Controlled
Injury Severity Score
Resuscitation / methods*
Wounds and Injuries / therapy*

Abstract in English, Spanish

Publication types

MeSH terms

Abstract
in English, Spanish