OBJECTIVE To determine if implementation of damage control resuscitation (DCR) in patients undergoing damage control laparotomy (DCL) translates into improved survival. SUMMARY BACKGROUND DATA DCR aims at preventing coagulopathy through permissive hypotension, limiting crystalloids and delivering higher ratios of plasma and platelets. Previous work has focused only on the impact of delivering higher ratios (1:1:1). METHODS A retrospective cohort study was performed on all DCL patients admitted between 01/2004–08/2010. Patients were divided into pre-DCR implementation and DCR groups, and were excluded if they died prior to completion of the initial laparotomy. The lethal triad was defined as immediate post-operative temperature <95° F, INR>1.5, or a pH<7.30. RESULTS 390 patients underwent DCL. Of these, 282 were pre-DCR and 108 were DCR. Groups were similar in demographics, injury severity, admission vitals and laboratory values. DCR patients received less crystalloids (median 14 L vs. 5 L), RBC (13 U vs. 7 U), plasma (11 U vs. 8 U) and platelets (6 U vs. 0 U) in 24-hr; all p<0.05. DCR patients had less evidence of the lethal triad upon ICU arrival (80% vs. 46%, p<0.001). 24-hour and 30-day survival were higher with DCR (88% vs. 97%, p=0.006 and 76% vs. 86%, p=0.03). Multivariate analysis controlling for age, injury severity, and ED variables, demonstrated DCR was associated with a significant increase in 30-day survival (O.R. 2.5, 95% C.I. 1.10–5.58, p=0.028). CONCLUSION In patients undergoing DCL, implementation of DCR reduces crystalloid and blood product administration. More importantly, DCR is associated with an improvement in 30-day survival.

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Purpose of review Progression of heart failure (HF) and its unpredictable and volatile nature, often requires advanced therapies including heart transplant. Mechanical circulatory support plays an integral part in the advanced treatment options. This technology can be deployed in several ways, particularly in the preparation and patient optimization for heart transplants. This article discusses the use of temporary and durable devices and their deployment strategies in the pre and posttransplant period. Recent findings Recently temporary mechanical support devices have allowed us to improve survival to transplant as well as posttransplant. Early implementation of temporary devices both for stabilization of advanced HF patients being considered for transplant as well as those with posttransplant primary graft dysfunction (although utilization of extracorporeal membrane oxygenation has repeatedly shown to be associated with worse outcomes compared to the other devices discussed), is reflective of the degree of disease progression in these patients. The outcomes of patients supported with durable devices have significantly improved with advancing technology. HeartMate 3 device has not only been shown to improve survival as well as the quality of life but in comparison to its predecessor, has been shown to decrease the morbidity associated with this technology. Summary Both temporary and durable devices are now associated with improved survival and allow us to transplant patients in a more stable and safer manner with fewer adverse events. Based on the new United Network of Organ Sharing allocation system, it allows us to upgrade those who do not have the luxury of time to wait for a transplant. Primary graft dysfunction now also can be assisted with those devices, which is reflected in improved survival of posttransplant patients.

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