Damage Control Resuscitation Is Associated With a Reduction in Resuscitation Volumes and Improvement in Survival in 390 Damage Control Laparotomy Patients

Cotton, Bryan A.; Reddy, Neeti; Hatch, Quinton; Lefebvre, E.; Wade, Charles E.; Kozar, Rosemary A.; Gill, Brijesh S.; Albarado, Rondel; McNutt, Michelle K.; Holcomb, John B.

doi:10.1097/sla.0b013e318230089e

Cited by 365 publications

(231 citation statements)

References 43 publications

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“…These changes have resulted in decreases in the inflammatory consequences of resuscitation (including acute respiratory distress syndrome [ARDS] and multiple organ failure), the number of operations (open abdomens), the amount of blood product used in bleeding patients, and an improvement in early and long-term survival. 16 We have recognized one case of transfusion-related acute lung injury (TRALI) in our trauma patients in the past 5 years. It is our opinion that earlier use of plasma, platelets, and RBCs and decreased use of crystalloids results in faster hemorrhage control and improved clinical outcomes.…”

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Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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“…This subsequently evolved to a target MAP of ~65 mmHg, [11,12] or even a MAP as low as 50 mmHg, as part of 'damage control resuscitation' . [13,14] This is different from a patient with acute coronary syndrome and a hypertensive emergency requiring that the SBP brought down to <180 mmHg to decrease the risk of intracerebral haemorrhage during thrombolysis. The septic patient requires early goaldirected therapymaintenance of the MAP at 65 mmHg with fluids and vasoactive agents as part of shock treat ment.…”

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confidence: 99%

Blood pressure measurements in the ankle are not equivalent to blood pressure measurements in the arm

2014

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Background. Blood pressure (BP) is often measured on the ankle in the emergency department (ED), but this has never been shown to be an acceptable alternative to measurements performed on the arm. Objective. To establish whether the differences between arm and ankle noninvasive BP measurements were clinically relevant (i.e. a difference of ≥10 mmHg). Methods. This was a prospective crosssectional study in an urban ED making use of a convenience sample of 201 patients (18 50 years of age) who were not in need of emergency medical treatment. BP was measured in the supine position on both arms and ankles with the correct size cuff according to the manufacturer's guidelines. The arm and ankle BP measurements were compared. Results. There was a clinically and statistically significant difference between arm and ankle systolic BP (SBP) and mean arterial pressure (MAP) (-13 mmHg, 95% confidence interval (CI) -28 1 mmHg and -5 mmHg, 95% CI -13 4 mmHg, respectively), with less difference in diastolic BP (DBP) (2 mmHg, 95% CI -7 10 mmHg). Only 37% of SBP measurements and 83% of MAP measurements were within an error range of 10 mmHg, while 95% of DBP measurements agreed within 10 mmHg. While the average differences (or the bias) were generally not large, large variations in individual patients (indicating poor precision) made the prediction of arm BP from ankle measurements unreliable. Conclusion. Ankle BP cannot be used as a substitute for arm BP in the ED.

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“…Since 2004, several studies have been done to evaluate the outcomes related to different massive transfusion practices, with mixed results. [42][43][44][45] Many of the studies had methodological issues given the nature of trauma research, 46 especially in a war zone. Thus, clinicians do not have definitive guidance on the correct ratio or safety of massive transfusions.…”

Section: Massive Transfusions and Blood Product Ratiosmentioning

confidence: 99%

Research in Review: Driving Critical Care Practice Change

Bridges

McNeill

Munro

2016

American Journal of Critical Care

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During the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. This article summarizes some of this important work and considers it in the context of previous research and practice. Examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma. Care challenges addressed include ethical considerations in light of the Ebola epidemic, infection prevention associated with chlorhexidine bathing, bedside alarm management, evidence to enhance moral courage, and interventions to mitigate thirst in critically ill patients. Research that portends future care includes a discussion of fecal microbiota transplant for patients with refractory infection with Clostridium difficile.

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Damage Control Resuscitation Is Associated With a Reduction in Resuscitation Volumes and Improvement in Survival in 390 Damage Control Laparotomy Patients

Cited by 365 publications

References 43 publications

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Blood pressure measurements in the ankle are not equivalent to blood pressure measurements in the arm

Research in Review: Driving Critical Care Practice Change

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