Damage control approach to refractory neurogenic shock: a new proposal to a well-established algorithm

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Vascular Surgery

Background:

• Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a critical tool for managing non-compressible torso hemorrhage.
• REBOA supports central aortic pressure, crucial for perfusion in conditions like neurogenic shock.

Purpose of the Study:

• To propose a novel damage control algorithm for refractory neurogenic shock.
• To investigate the adjunct use of REBOA in Zone 3 for neurogenic shock management.

Main Methods:

• Literature review and clinical experience synthesis.
• Development of a proposed algorithmic approach for refractory neurogenic shock.

Main Results:

• REBOA can be a valuable adjunct in carefully selected neurogenic shock cases.
• Potential to prevent prolonged hypotension and mitigate anoxic spinal cord injury risk.

Conclusions:

• REBOA in Zone 3 may benefit trauma patients with refractory neurogenic shock.
• Further research is needed on spinal cord perfusion and functional outcomes with REBOA in this context.