7 - Damage Control and Immediate Resuscitation for Vascular Trauma

Abstract

Vascular disruption followed by hemorrhage is a common cause of early avoidable death following trauma. Damage control resuscitation (DCR) is an overarching concept that encompasses all efforts from point of injury through damage control surgery (DCS) and intensive care. The aims of DCR are to arrest bleeding, to optimize oxygenation, and to improve survival. The wise surgeon understands that knowing and adhering to the principles of DCR after major vascular trauma is as important as choosing and performing the best or most-intricate vascular reconstruction. The concept of DCR has developed in parallel with the advances in contemporary combat casualty care, now being transferred into civilian management of vascular trauma. These advances include a change in the paradigm of initial assessment and treatment (the addition of C or catastrophic hemorrhage to the traditional ABCs), the introduction of topical hemostatics to control external bleeding, and profound changes in the use of blood products to manage coagulopathy. As a precursor to Chapter 8, Noncompressible Torso Hemorrhage by Morrison and DuBose, this chapter focuses on the hospital approach to resuscitation following vascular trauma and hemorrhage, drawing out recent advances in this arena. Resuscitation end-points are given, where these can provide a handrail in a complex clinical scenario. The ethics of resuscitation at hospital are also covered recognizing that these decisions are more pressing when resources are constrained in the field hospital or wartime environment.