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2016 ; 42
(3
): 273-82
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Damage control resuscitation: lessons learned
#MMPMID26847110
Giannoudi M
; Harwood P
Eur J Trauma Emerg Surg
2016[Jun]; 42
(3
): 273-82
PMID26847110
show ga
BACKGROUND: Damage control resuscitation describes an approach to the early care
of very seriously injured patients. The aim is to keep the patient alive whilst
avoiding interventions and situations that risk worsening their situation by
driving the lethal triad of hypothermia, coagulopathy and acidosis or excessively
stimulating the immune-inflammatory system. It is critical that the concepts and
practicalities of this approach are understood by all those involved in the early
management of trauma patients. This review aims to summarise this and discusses
current knowledge on the subject. INTERVENTIONS: Damage control resuscitation
forms part of an overall approach to patient care rather than a specific
intervention and has evolved from damage control surgery. It is characterised by
early blood product administration, haemorrhage arrest and restoration of blood
volume aiming to rapidly restore physiologic stability. The infusion of large
volumes of crystalloid is no longer appropriate, instead the aim is to replace
lost blood and avoid dilution and coagulopathy. In specific situations,
permissive hypotension may also be of benefit, particularly in patients with
severe haemorrhage from an arterial source. As rapid arrest of haemorrhage is so
important, team-based protocols that deliver patients rapidly but safely, via CT
scan where appropriate, to operating theatres or interventional radiology suites
form a critical part of this process. CONCLUSIONS: Given that interventions are
so time dependent in the severely injured, it is likely that by further improving
trauma systems and protocols, improvements in outcome can still be made. Further
research work in this area will allow us to target these approaches more
accurately to those patients who can benefit most.
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