Open AccessDamage control approach to refractory neurogenic shock: a new proposal to a well-established algorithm
Author(s) -
Michael W. Parra,
Carlos A. Ordóñez,
David Mejia,
Yaset Caicedo,
Javier Mauricio Lobato,
Óscar Javier Castro,
Juan Alfonso Uribe,
Fernando Velásquez
Publication year - 2021
Publication title -
colombia medica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.455
H-Index - 18
eISSN - 1657-9534
pISSN - 0120-8322
DOI - 10.25100/cm.v52i2.4800
Subject(s) - medicine , spinal cord injury , resuscitation , anesthesia , perfusion , spinal cord , refractory (planetary science) , surgery , cardiology , psychiatry , physics , astrobiology
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is commonly used as an adjunct to resuscitation and bridge to definitive control of non-compressible torso hemorrhage in patients with hemorrhagic shock. It has also been performed for patients with neurogenic shock to support the central aortic pressure necessary for cerebral, coronary and spinal cord perfusion. Although volume replacement and vasopressors are the cornerstones of the management of neurogenic shock, we believe that a REBOA can be used as an adjunct in carefully selected cases to prevent prolonged hypotension and the risk of further anoxic spinal cord injury. This manuscript aims to propose a new damage control algorithmic approach to refractory neurogenic shock that includes the use of a REBOA in Zone 3. There are still unanswered questions on spinal cord perfusion and functional outcomes using a REBOA in Zone 3 in trauma patients with refractory neurogenic shock. However, we believe that its use in these case scenarios can be beneficial to the overall outcome of these patients.