REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients
Abstract
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.
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Keywords
- Resuscitative Endovascular Balloon Occlusion of the Aorta ;
- Damage Control
- Non-Compressible Torso Hemorrhage
- Hemodynamically Unstable
- Wounds, Gunshot
- Injury Severity Score
- Trauma Centers
- Advanced Trauma Life Support Care
- Balloon Occlusion
- Wounds, Nonpenetrating
- Endovascular Procedures
- REBOA
Author Biographies
, 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.
https://orcid.org/0000-0003-4495-7405
, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA
https://orcid.org/0000-0001-6496-6275
, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
https://orcid.org/0000-0002-6128-0128
, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia
https://orcid.org/0000-0002-5326-2317
, • 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.
https://orcid.org/0000-0001-9829-8930
, • 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
, • 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.
, 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
https://orcid.org/0000-0002-2249-9960
, 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
https://orcid.org/0000-0002-1179-2854
, • Department of Surgery, Hospital Pablo Tobon Uribe, Medellin, Colombia. • Department of Surgery, Universidad de Antioquia, Medellin, Colombia.
https://orcid.org/0000-0003-0617-4303
, • Division of Trauma and Acute Care Surgery. Hospital Vicente Corral Moscoso, Cuenca, Ecuador. • Escuela de Medicina. Universidad del Azuay, Cuenca, Ecuador.
, Department of Surgery, University of California Riverside, Riverside, California - USA
https://orcid.org/0000-0002-6917-4768
, Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital. Örebro, Sweden
https://orcid.org/0000-0003-3912-4732
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