Damage Control Resuscitation: The New Face of Damage Control

Duchesne, Juan; McSwain, Norman E.; Cotton, Bryan A.; Hunt, John P.; Dellavolpe, Jeff; Lafaro, Kelly J.; Marr, Alan B.; Gonzalez, Earnest A; Phelan, Herb A.; Bilski, Tracy; Greiffenstein, Patrick; Barbeau, J. Mills; Rennie, Kelly V.; Baker, Christopher C.; Brohi, Karim; Jenkins, Donald H.; Rotondo, Michael F.

doi:10.1097/ta.0b013e3181f2abc9

Cited by 239 publications

(210 citation statements)

References 96 publications

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“…The pH of 0.9% IS is only 5 and along with the high sodium and chloride load is responsible for the development of the hyperchloraemic metabolic acidosis [11]. Surprisingly, despite the presence of the two isomers of Lactate Acid (D and L), LR with the pH of 6.5 is more alkalising solution than IS [10,18].…”

Section: Crystalloids: 09% Isotonic Saline and Lactate Ringersmentioning

confidence: 99%

“…The isomer L is a naturally occurring one, so can be easily metabolised by the body [24]. In contrast, D-isomer, which cannot be metabolised, is associated with neutrophils activation and subsequently leads to the development of systemic inflammatory response syndrome (SIRS) [11,17,26]. LR cannot be used for infusion with red blood cells, because it leads to the clotting of the blood filters due to calcium citrate content [11].…”

Section: Crystalloids: 09% Isotonic Saline and Lactate Ringersmentioning

confidence: 99%

“…7.5% HTS is associated with the reduction of intracranial pressure in head injuries and fewer complications, such as ARDS or sepsis [11,31,32]. It has the potential of increasing blood pressure with lower volumes (250 mls) due to rapid shifts of the fluid between the cellular and interstitial spaces [29,31,33].…”

Section: Hypertonic Saline (Hts)mentioning

confidence: 99%

“…Despite this simple logic, the past management of trauma patients for many years was based on the belief that the use of large volumes of intravenous crystalloids is essential to restore the circulating volume and to achieve the best outcomes [9]. However, several studies found this to be harmful, because it exacerbates the lethal triad (acidosis, coagulopathy and hypothermia) and shock induced inflammatory response [10][11][12]. This subsequently leads to profound systemic and cellular complications, which cause adult respiratory distress syndrome (ARDS), multi organ dysfunction syndrome (MODS) and death [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…DCR aims to salvage the trauma patient from disturbed physiology by breaking the lethal triad [14]. DCR utilises three key concepts: permissive hypotension, rapid correction of the coagulopathy and early use of blood products as primary resuscitation fluids (instead of IVF) [8,11]. This appears to be logical giving the fact that all fluids including crystalloids and colloids have the ability to worsen the shock and coagulopathy [15].…”

Section: Introductionmentioning

confidence: 99%

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Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

Kaczynski¹,

Wilczynska²,

Hilton³

et al. 2013

Emerg Med Health Care

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Background: During resuscitation trauma patients receive various intravenous fluids, which can exacerbate coagulopathy and haemorrhage further. This led to the introduction of the damage control resuscitation, which advocates minimal intravenous fluids use. However, some fluid may be required in uncontrolled haemorrhage or when blood products are not immediately available. Furthermore, questions regarding the type and volume of the administered fluids remain still unanswered. Methods: Review of literature. Results: Crystalloids such as 0.9% Isotonic Saline and Lactate Ringers can cause either a hypercoagulable (lower dilutions) or hypocoagulable (higher dilutions) derangements. Hypertonic Saline (7.5%) leads to more pronounced coagulation abnormalities when compared with 0.9% Isotonic Saline. The effects of the 7.5% Hypertonic Saline combined with 6 % Dextran 70 are controversial. Some authors reported significant clotting abnormalities, but others found an improvement in the haemodynamic parameters. The evidence on human albumin solution use in trauma is very limited and suggests a procoagulant effect at lower dilutions. Gelofusine even with smaller volumes leads to pronounced coagulation abnormalities. All Dextrans (40 and 70) cause significant hypocoagulability at lower dilutions. Similarly lower molecular starches demonstrate a definite hypocoagulable effect. Conclusions: A literature review has also indicated that none of the studies demonstrated survival or outcome benefit associated with a particular type and volume of administered intravenous fluids. The results are controversial and further research is needed to clarify this issue.

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Section: Crystalloids: 09% Isotonic Saline and Lactate Ringersmentioning

confidence: 99%

Section: Crystalloids: 09% Isotonic Saline and Lactate Ringersmentioning

confidence: 99%

Section: Hypertonic Saline (Hts)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

Kaczynski¹,

Wilczynska²,

Hilton³

et al. 2013

Emerg Med Health Care

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An Emergency Department Thawed Plasma Protocol for Severely Injured Patients

Radwan¹,

Bai²,

Matijevic³

et al. 2013

JAMA Surg

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Objectives To expedite delivery and transfusion of plasma through implementation of an emergency department (TP-ED) protocol. Design Retrospective cohort study Setting ACS-verified level 1 trauma center Patients Protocol was initiated February 2010, placing four units of AB plasma in the ED. All trauma patients admitted eight months before (TP-BB) and after implementing the TP-ED protocol. Patients were included if they received at least one unit of RBC and one unit of plasma in the first six hours after ED admission. Main Outcome Measures Primary outcome was time to first unit of plasma. Secondary outcomes included 24-hour blood use and 24-hour and 30-day mortality. Results 294 patients met study criteria (130 TP-BB, 164 TP-ED). While demographics were similar, TP-ED patients had greater anatomic injury (median ISS 18 vs. 25, p=0.018) and more physiological disturbances (median w-RTS 6.81 vs. 3.83, p=0.008). TP-ED had shorter time to first plasma transfusion (83 min vs. 42 min, p<0.001). TP-ED was associated with a reduction in 24-hour transfusion of RBC (p=0.036), plasma (p=0.044), and platelets (p<0.001). Logistic regression identified TP-ED as an independent predictor of decreased 30-day mortality (OR 0.43, 95% C.I. 0.194–0.956, p=0.038). Conclusions We demonstrated that implementation of a ED-TP protocol expedites transfusion of plasma to severely injured patients. This approach is associated with a reduction in overall blood product use and a 60% decreased odds in 30-day mortality.

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Stopping the Bleeding

Hiatt¹

2013

JAMA Surg

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Damage Control Resuscitation: The New Face of Damage Control

Cited by 239 publications

References 96 publications

Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

An Emergency Department Thawed Plasma Protocol for Severely Injured Patients

Stopping the Bleeding

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