Fundación Valle del Lili. Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.
Universidad del Valle, Facultad de Salud, Escuela de Medicina. Cali, Colombia.
Colomb Med (Cali). 2020 Dec 30;51(4):e4014353. 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.
损伤控制性复苏（DCR）旨在通过以下三个主要方面来对抗严重创伤患者的代谢失调：允许性低血压、止血复苏和损伤控制性手术（DCS）。本文的目的是回顾 DCR/DCS 的历史，并提出一个新的范例，这个范例源自最近血管内技术的进步：主动脉球囊阻断复苏（REBOA）。得益于技术的进步，在 DCS 的第一阶段描述的院前管理和出血控制之间架起了一座桥梁，即包括和放置 REBOA。我们已经能够证明，REBOA 不仅是一种有助于控制出血的工具，也是严重钝性和/或穿透性创伤患者血流动力学复苏的重要工具。这就是为什么我们提出了一个新的范例“第四大支柱”：允许性低血压、止血复苏、损伤控制性手术和 REBOA。
