Balón de reanimación endovascular de aorta para pacientes en riesgo de o en choque hemorrágico: experiencia en un centro de trauma de Latinoamérica

Meléndez, Juan J.; Ordóñez, Carlos A.; Parra, Michael W.; Orlas, Claudia; Manzano-Núñez, Ramiro; García, Alberto; Salazar, Camilo; Londoño, Maria Alejandra Cifuentes; Ruiz, J; Serna, José Julián; Angamarca, Edinson; Salcedo, Alexander; Peña, Carlos Eduardo Cubillos; Rodríguez, Fernando

doi:10.30944/20117582.106

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…We propose a new paradigm "The Fourth Pillar": Permissive Hypotension, Hemostatic Resuscitation, Damage Control Surgery and REBOA ( Figure 6). To this point, we have extended the indications of REBOA use and have applied it to salvage patients with penetrating and blunt trauma not only of the abdomen and pelvis 40,44 but also of the chest which until our reported initial successful experience was considered a contraindication 42,46,[51][52][53] . However, we are not promoting its vast use for all trauma patients but instead its use in specific well indicated dire scenarios of hemodynamic instability from ongoing non-compressible torso hemorrhage and impending cardiac arrest 54 .…”

Section: Stage: Reboa Resuscitative Balloon Occlusion Of the Aortamentioning

confidence: 99%

Damage control resuscitation: REBOA as the new fourth pillar

et al. 2020

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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.

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Section: Stage: Reboa Resuscitative Balloon Occlusion Of the Aortamentioning

confidence: 99%

Damage control resuscitation: REBOA as the new fourth pillar

et al. 2020

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“…REBOA is an important resuscitative tool that ultimately prevents hemodynamic collapse while at the same time maintains coronary and cerebral perfusion in hemodynamically unstable trauma patients, and due to its less invasive nature, it has become an alternative to resuscitative thoracotomy [9][10][11][12][13][14][15][16] . Hörer et al proposed the concept of Endovascular Resuscitation and Trauma Management, a vision that integrates a multidisciplinary patient-centered approach that achieves prompt and effective hemorrhage control with significantly less surgical insult 6,17 .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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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“…Also, REBOA has been consolidated as an additional endovascular tool that aids in the early control of hemorrhage and hemodynamic support 14 , 15 . In the United States of America, REBOA has been used for infra diaphragmatic injuries; however, our experience has shown promising clinical results even in thoracic trauma 16 , 17 . It is important to note that to carry out all the measures mentioned above.…”

Section: Conceptsmentioning

confidence: 91%

“…Actualmente, el uso del REBOA, dispositivo que permite el clampeo endovascular de la aorta torácica o abdominal para el control proximal del sangrado, se está consolidando como nuevo miembro del equipo de trauma dado a su potencial y versatilidad 14 , 15 . En Norteamérica ha sido utilizado principalmente en trauma infra diafragmático; sin embargo, la experiencia del CTE ha demostrado buenos resultados clínicos incluso en trauma torácico 16 , 17 .…”

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Damage control in the emergency department, a bridge to life

et al. 2021

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Patients with hemodynamic instability have a sustained systolic blood pressure less or equal to 90 mmHg, a heart rate greater or equal to 120 beats per minute and an acute compromise of the ventilation/oxygenation ratio and/or an altered state of consciousness upon admission. These patients have higher mortality rates due to massive hemorrhage, airway injury and/or impaired ventilation. Damage control resuscitation is a systematic approach that aims to limit physiologic deterioration through a group of strategies that address the physiologic debt of trauma. This article aims to describe the experience earned by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia in the management of the severely injured trauma patient in the emergency department following the basic principles of damage control surgery. Since bleeding is the main cause of death, the management of the severely injured trauma patient in the emergency department requires a multidisciplinary team, which should perform damage control maneuvers aimed at rapidly control bleeding, hemostatic resuscitation and/or prompt transfer to the operating room, if required.

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Balón de reanimación endovascular de aorta para pacientes en riesgo de o en choque hemorrágico: experiencia en un centro de trauma de Latinoamérica

Abstract: Este es un artículo de acceso abierto bajo una Licencia Creative Commons -BY-NC-ND https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es Balón de reanimación endovascular de aorta para pacientes en riesgo o en choque hemorrágico: experiencia en un centro de trauma de Latinoamérica

Cited by 6 publications

References 10 publications

Damage control resuscitation: REBOA as the new fourth pillar

Damage control resuscitation: REBOA as the new fourth pillar

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

Damage control in the emergency department, a bridge to life

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