Damage control resuscitation: REBOA as the new fourth pillar

Abstract

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.

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

Figure 1. The Lethal Triad

Figure 2. Damage Control Resuscitation: Classic Description

Figure 3. The Lethal Diamond

Figure 4. The Four Stages of DCS

Figure 5. Damage Control Surgery: Stages including REBOA

Figure 6. REBOA as an integral component of DCR/DCS

Figura 1. La triada letal

Figura 2. Resucitación en control de daños: descripción clásica

Figura 3. El diamante letal

Figura 4. Las cuatro etapas de la cirugía del control de daños

Figura 5. Cirugía del control de daños: Estados que incluyen REBOA

Figura 6. REBOA como un componente integral de resucitación de control de daños /cirugía del control de daños