Advances in Resuscitation in the Setting of Vascular Injury

Abstract

Damage control surgery with the principles of expeditious control of hemorrhage and contamination, followed by predominant crystalloid resuscitation in the intensive care unit has saved the lives of many severely injured trauma patients. Unfortunately, crystalloid resuscitation has too often led to worsening of coagulopathy in the setting of vascular injury. The recent conflicts in Iraq and Afghanistan have created injured patients with severe vascular injury and massive soft tissue destruction creating early and profound coagulopathy associated with high rates of mortality. An alternative strategy, known as damage control resuscitation, with the principal resuscitation of a 1:1 ratio of packed red blood cells and fresh frozen plasma has been developed during these conflicts. This method is associated with decreased mortality and improved limb salvage in military and civilian trauma patients.

A Biochemical Approach to Understand the Pathogenesis of Advanced Pulmonary Arterial Hypertension: Metabolomic Profiles of Arginine, Sphingosine-1-Phosphate, and Heme of Human Lung

“…Hence increased heme degradation may be the result of increased hemolysis, and may explain why heme biosynthesis was not increased in our study. Studies from Fox et al indicate that high erythrocyte creatine levels are an indicator of hemolysis [ 39 ]. In addition, Hebbe et al concluded that red blood cell survival is the gold-standard test for hemolysis [ 39 ].…”

“…Studies from Fox et al indicate that high erythrocyte creatine levels are an indicator of hemolysis [ 39 ]. In addition, Hebbe et al concluded that red blood cell survival is the gold-standard test for hemolysis [ 39 ]. They found that patients with PAH had subclinical hemolysis, as shown by higher EC levels [ 39 ].…”

“…In addition, Hebbe et al concluded that red blood cell survival is the gold-standard test for hemolysis [ 39 ]. They found that patients with PAH had subclinical hemolysis, as shown by higher EC levels [ 39 ]. In addition, elevated EC levels may also explain why creatine levels were increased in arginine metabolism.…”

Damage control resuscitation: lessons learned

“…In polytrauma patients it has been associated with increased bleeding morbidity, higher transfusion requirements, increased risk of organ dysfunction, longer critical care stays and increased overall mortality [ 12 – 14 ]. The severity of post traumatic coagulopathy has been shown to directly correlate with overall injury severity [ 15 ]. Once established this state is extremely difficult to correct and is a potent cause of early death in such patients.…”

Management of Penetrating Trauma to the Major Abdominal Vessels

“…In civilian settings, the recent multi-institutional investigation by DuBose and colleagues reported 7.8 % vascular injuries to the intra-abdominal vessels admitted to 13 US trauma facilities [5••]. The increasing incidence of vascular injuries arriving to medical care in the USA can be associated with truncated on-scene times, evolving prehospital management, and hemostatic resuscitation [6].…”