Damage control resuscitation: REBOA as the new fourth pillar

• Published in: Colombia médica (Cali, Colombia) Colombia), 2020-12, Vol.51 (4), p.e4014353
• Main Authors: Ordoñez, Carlos Alberto, Parra, Michael, Serna, Jose Julian, Rodriguez, Fernando, Garcia, Alberto, Salcedo, Alexander, Caicedo, Yaset, Padilla, Natalia, Pino, Luis Fernando, González Hadad, Adolfo, Herrera, Mario Alain, Millán Lozano, Mauricio, Quintero, Laureano, Hernandez, Fabian, Ferrada, Ricardo, Brenner, Megan, Rasmussen, Todd, Scalea, Thomas, Ivatury, Rao, Holcomb, John
• Format: Article
• Language: English
• Subjects: Review
• ISSN: 0120-8322; 1657-9534
• DOI: 10.25100/cm.v51i4.4353

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.