REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

摘要

Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient. Authors Carlos Alberto Ordoñez Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Universidad Icesi, Cali, Colombia. .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0003-4495-7405 Michael Parra Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0001-6496-6275 Yaset Caicedo Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0002-6128-0128 Natalia Padilla Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0003-3292-6919 Fernando Rodriguez Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0002-5326-2317 Jose Julian Serna • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0001-9829-8930 Alexander Salcedo • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitar .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0001-8187-0638 Alberto Garcia • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0002-4096-1434 Claudia Patricia Orlas Center for Surgery and Public Health, Department of Surgery, Brigham Women’s Hospital, Harvard Medical School Harvard T.H. Chan School of Public Health, Boston – USA .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0002-2249-9960 Luis Fernando Pino Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Colombia. 6. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0002-1179-2854 Ana Milena del Valle Division of Surgery, Hospital Felix Bulness. Santiago de Chile, Chile. David Alejandro Mejia • Department of Surgery, Hospital Pablo Tobon Uribe, Medellin, Colombia. • Department of Surgery, Universidad de Antioquia, Medellin, Colombia. .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0003-0617-4303 Juan Carlos Salamea • Division of Trauma and Acute Care Surgery. Hospital Vicente Corral Moscoso, Cuenca, Ecuador. • Escuela de Medicina. Universidad del Azuay, Cuenca, Ecuador. .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0002-9084-3030 Megan Brenner Department of Surgery, University of California Riverside, Riverside, California - USA .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0002-6917-4768 Tal Hörer Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital. Örebro, Sweden .st0{fill:#A6CE39;} .st1{fill:#FFFFFF;} https://orcid.org/0000-0003-3912-4732 Downloads Download data is not yet available.