Damage control resuscitation in adult trauma patients: What you need to know

Abstract

Death after injury is a worldwide epidemic. Hemorrhage as a cause of death represents the leading potentially preventable condition. Based on hard-won experience from the recent wars, and two decades of military and civilian research, damage-control resuscitation (DCR) is now widely used. This article will briefly describe the history of blood transfusion, outline “why we do DCR,” and then discuss “how we do DCR.” Modern DCR occurs both prehospital and in the hospital and has several main tenants. Currently, DCR focuses on the liberal use of temporary hemorrhage-control adjuncts, early use of whole blood or balanced blood product-based transfusions, mitigation of crystalloid use, hypotensive resuscitation to promote hemostasis and decrease coagulopathy, and correction of ongoing metabolic derangements, followed by rapid definitive hemorrhage control. These concepts have evolved from a series of lessons learned over time from both civilian and military trauma casualties, and DCR is now the standard of care in trauma resuscitation.

Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

“…Meanwhile, we recommend the early reversal of anticoagulant/antiplatelet agents in tSCI polytrauma patients needing interventions for life-threatening hemorrhage or emergency spinal surgery. Massive transfusion is frequently utilized in bleeding trauma patients [ 14 , 40 ]. The pragmatic randomized optimal platelet and plasma ratios (PROPPR) study, involving 680 trauma patients with major bleeding, was performed to determine the safety and the effectiveness of a transfusion strategy involving plasma, PLTs and RBCs in a 1:1:1 ratio compared with a 1:1:2 ratio.…”

Does the injury pattern drive the surgical treatment strategy in multiply injured patients with major fractures?

“…10,30 A growing body of literature has recommended the use of different pathophysiologic parameters ("holistic physiologic status"). 13,40 Among those is the description of the so-called "diamond of death," which includes acidosis, hypothermia, coagulopathy, and hypocalcemia. 41 The present study showed improved prediction of outcomes when both the anatomic injury distribution and a holistic pathophysiologic approach were applied.…”

Receipt of RhD‐positive whole blood for life‐threatening bleeding in female children: A survey in alloimmunized mothers regarding minimum acceptable survival benefit relative to risk of maternal alloimmunization to anti‐D

“…Mortality rates in children with severe bleeding from trauma or medical etiologies range between 36% and 60%, 1 whereas in adults with trauma it ranges between 20% and 24% 2 . Death from traumatic hemorrhage is the most common preventable cause of death after injury due to inadequate or delayed care 3–6 …”

“…In the United States, these blood products are administered in either a balanced ratio of blood components or with low titer group O whole blood (LTOWB) 7–10 . Based on emerging evidence that demonstrates potential efficacy and safety, LTOWB is now utilized in over 300 US trauma centers in both adults and children with hemorrhagic shock 5,6,11 . Studies in adults and children indicate an independent association with improved 24‐hour or 28‐day survival 12–16 …”