Damage Control Resuscitation

Abstract

Damage control surgery is a combination of temporizing surgical interventions to arrest hemorrhage and control infectious source, with goal directed resuscitation to restore normal physiology. The convention of damage control surgery largely arose following the discovery of the lethal triad of hypothermia, acidosis, and coagulopathy, with the goal of Damage Control Surgery (DCS) is to avoid the initiation of this “bloody vicious cycle” or to reverse its progression. While hypothermia and acidosis are generally corrected with resuscitation, coagulopathy remains a challenging aspect of DCS, and is exacerbated by excessive crystalloid administration. This chapter focuses on resuscitative principles in the four settings of trauma care: the prehospital setting, emergency department, operating room, and intensive care unit including historical perspectives, resuscitative methods, controversies, and future directions. Each setting provides unique challenges with specific goals of care.

Field‐expedient thawing of fresh‐frozen plasma

“…P rehospital resuscitation is of critical importance for maximizing survivability following hemorrhage, and several studies have recognized that resuscitation with blood products is superior to using crystalloid solutions for damage control resuscitation. [1][2][3][4][5] While whole blood may be best to replace that which has been lost, it is difficult to maintain in sufficient quantities, and its usage is limited despite evidence suggesting its superiority to other resuscitation solutions in many instances. [6][7][8] Until whole blood is widely available, freeze-dried plasma, oxygen carriers, and other adjuncts may become a significant part of resuscitation strategies in austere environments.…”

Endovascular balloon occlusion of the aorta in the complex of damage control resuscitation in patients with acute massive blood loss: a retrospective propensity score matched analysis

“…Основу лечения таких пациентов составляет быстрая и качественная догоспитальная помощь и по возможности раннее применение тактики «реанимации и интенсивной терапии при травмах» (что примерно соответствует концепции, обозначенной в англоязычной литературе как damage control resuscitation [DCR]). Ключевыми элементами послед -ней являются: акцент на поиск и остановку продолжающегося кровотечения в ходе первичного обследования (протокол «C-ABC», где первая «С» -Catastrophic hemorrhage, массивное кровотечение), управляемая артериальная гипотония как метод контролируемой остановки кровотечения, «агрессивная» трансфузионная и минимальная инфузионная терапия в целях предотвращения острой посттравматической коагулопатии, гемостатическая «реанимация» с применением транексамовой кислоты и факторов свертывания и, наконец, хирургическая тактика сокращенных вмешательств damage control surgery [1][2][3].…”

From Death Triad to Death Tetrad—The Addition of a Hypotension Component to the Death Triad Improves Mortality Risk Stratification in Trauma Patients: A Retrospective Cohort Study

“…Each component of the death triad had a negative impact on patient survival, and the relationship between the death triad and mortality was clear and validated [ 1 , 8 ]. Among the three components of the death triad, metabolic acidosis has been proven to be associated with increased mortality [ 9 ], coagulopathy was related to a 4- to 5-fold increase in mortality following major trauma [ 10 ], and hypothermia contributes not only to mortality associated with the injury but also to fluid requirements and duration of surgery [ 7 , 11 ].…”