<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1657-9534</journal-id>
<journal-title><![CDATA[Colombia Médica]]></journal-title>
<abbrev-journal-title><![CDATA[Colomb. Med.]]></abbrev-journal-title>
<issn>1657-9534</issn>
<publisher>
<publisher-name><![CDATA[Universidad del Valle]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1657-95342021000200416</article-id>
<article-id pub-id-type="doi">10.25100/cm.v52i2.4800</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Damage control approach to refractory neurogenic shock: a new proposal to a well-established algorithm]]></article-title>
<article-title xml:lang="es"><![CDATA[El control de daños en el choque neurogénico refractario: propuesta de un nuevo algoritmo de manejo]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Parra]]></surname>
<given-names><![CDATA[Michael W.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ordoñez]]></surname>
<given-names><![CDATA[Carlos A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="A a"/>
<xref ref-type="aff" rid="A4"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mejia]]></surname>
<given-names><![CDATA[David]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Caicedo]]></surname>
<given-names><![CDATA[Yaset]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lobato]]></surname>
<given-names><![CDATA[Javier Mauricio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Castro]]></surname>
<given-names><![CDATA[Oscar Javier]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Uribe]]></surname>
<given-names><![CDATA[Jose Alfonso]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Velásquez]]></surname>
<given-names><![CDATA[Fernando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Broward General Level I Trauma Center Department of Trauma Critical Care ]]></institution>
<addr-line><![CDATA[Fort Lauderdale FL]]></addr-line>
<country>USA</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Fundación Valle del Lili Department of Surgery Division of Trauma and Acute Care Surgery]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad del Valle Facultad de Salud Escuela de Medicina]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad Icesi  ]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Hospital Pablo Tobon Uribe Department of Surgery ]]></institution>
<addr-line><![CDATA[Medellin ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Universidad de Antioquia Department of Surgery ]]></institution>
<addr-line><![CDATA[Medellin ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,Fundación Valle del Lili Centro de Investigaciones Clínicas (CIC) ]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af8">
<institution><![CDATA[,Fundacion Valle del Lili Department of Neurosurgery ]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2021</year>
</pub-date>
<volume>52</volume>
<numero>2</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S1657-95342021000200416&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S1657-95342021000200416&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S1657-95342021000200416&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract 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.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen El Balón de Resucitación Endovascular de Oclusión Aórtica (REBOA) se utiliza habitualmente como complemento de la reanimación y como puente para el control definitivo de la hemorragia no compresible del torso en pacientes con shock hemorrágico. También se ha implementado en pacientes con choque neurogénico para mantener la presión aórtica central necesaria para la perfusión cerebral, coronaria y de la médula espinal. Aunque la reanimación hídrica y el uso de vasopresores son los pilares en el manejo del choque neurogénico, el REBOA puede utilizarse como complemento en casos cuidadosamente seleccionados para evitar la hipotensión prolongada y el riesgo de una lesión medular anóxica mayor. El objetivo de este artículo es proponer un algoritmo para el abordaje y manejo del choque neurogénico refractario que incluye el uso del REBOA en Zona III como estrategia para el control de daños. Todavía existen interrogantes respecto a la perfusión de la médula espinal y aún se cuestionan los resultados funcionales con el uso del REBOA en pacientes con trauma y choque neurogénico refractario. No obstante, se cree que el uso adecuado del REBOA en determinados escenarios puede mejorar los resultados globales de estos pacientes.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Damage Control Surgery]]></kwd>
<kwd lng="en"><![CDATA[Neurogenic Shock]]></kwd>
<kwd lng="en"><![CDATA[REBOA]]></kwd>
<kwd lng="en"><![CDATA[Algorithm]]></kwd>
<kwd lng="es"><![CDATA[Cirugía de Control de Daños]]></kwd>
<kwd lng="es"><![CDATA[Choque Neurogénico]]></kwd>
<kwd lng="es"><![CDATA[REBOA]]></kwd>
<kwd lng="es"><![CDATA[Algoritmo]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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