Damage control resuscitation: REBOA as the new fourth pillar / Resucitación en control de daños: REBOA, el cuarto pilar

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.

Resumen La resucitación en control de daños busca combatir la descompensación metabólica del paciente severamente traumatizado mediante tres ejes: la hipotensión permisiva, la resucitación hemostática y la cirugía de control de daños. El objetivo de este artículo es hacer una revisión de la historia de la resucitación en control de daños y la cirugía de control de daños proponiendo un nuevo paradigma basado en los recientes avances de la tecnología endovascular. Un puente ha sido creado entre el manejo prehospitalario y el control del sangrado, descrito antes de la etapa I de la cirugía de control de daños, que es la inclusión y colocación de un REBOA. Esta es una herramienta adicional en el control de la hemorragia y de soporte en la resucitación hemodinámica de los pacientes con trauma severo de tipo cerrado y/o penetrante. Por lo que se propone un nuevo paradigma "El cuarto pilar": Hipotensión permisiva, resucitación hemostática, cirugía de control de daños y REBOA.

Damage control resuscitation: REBOA as the new fourth pillar.

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.

La resucitación en control de daños busca combatir la descompensación metabólica del paciente severamente traumatizado mediante tres ejes: la hipotensión permisiva, la resucitación hemostática y la cirugía de control de daños. El objetivo de este artículo es hacer una revisión de la historia de la resucitación en control de daños y la cirugía de control de daños proponiendo un nuevo paradigma basado en los recientes avances de la tecnología endovascular. Un puente ha sido creado entre el manejo prehospitalario y el control del sangrado, descrito antes de la etapa I de la cirugía de control de daños, que es la inclusión y colocación de un REBOA. Esta es una herramienta adicional en el control de la hemorragia y de soporte en la resucitación hemodinámica de los pacientes con trauma severo de tipo cerrado y/o penetrante. Por lo que se propone un nuevo paradigma "El cuarto pilar": Hipotensión permisiva, resucitación hemostática, cirugía de control de daños y REBOA.

Sports injuries and ill-health episodes in the Cali 2013 World Games.

BACKGROUND: The World Games is a multisport event, second in importance only to the Olympic Games. Systematic surveillance of injuries and ill-health episodes is an essential part of modern integral healthcare given to athletes. AIM: To describe and analyse injuries and ill-health episodes affecting competitors during the Cali World Games 2013. METHODS: This is a cross-sectional study of injuries and ill-health episodes suffered by competing athletes. Entries to the registry were systematically recorded by official doctors and medical staff at the Games, and included attention to emergencies at the sport venues and data of reports received from health facilities around the city. RESULTS: In all, 2824 athletes, 1216 women and 1608 men, participated in the 2013 Cali World Games. There were 88 injuries and 29 ill-health episodes, for an overall incidence of 31.2 injuries and 10.3 ill-health episodes per 1000 athletes, over an 11 day period. The highest incidence of sport associated injuries affected jiu-jitsu athletes. Hands were the most common site of injury. Injury rates for men and women were 35.5 and 25.5/1000 athletes, respectively, (RR=1.41, 95% CI 0.90 to 2.19, p=0.066). National delegations with less than 25 athletes suffered more injuries compared to larger delegations, with 40.9 vs 29.2 injuries per 1000 athletes (RR 1.4, 95% CI 0.85 to 2.30, p=0.12). The gastrointestinal system was the most affected by illness. The sport where most competitors suffered ill-health episodes was softball. The rate of ill-health episodes in women was 15/1000, and for men 6.8/1000 athletes (RR=2.16, 95% CI 1.03 to 4.56, p=0.038). CONCLUSIONS: 3.1% of the athletes had sport-related injuries, and 1% had at least one episode of ill health. These are low numbers compared to other multisport events such as the Olympic Games. Men had a higher incidence of injuries, and women a higher incidence of episodes of ill health. Future World Games should improve data-collection strategies and develop preventive measures accordingly.