Damage Control Resuscitation in the Trauma Patient

Abstract

Unintentional trauma is the leading cause of death among individuals younger than 45 years of age and the primary reason for productive years of life lost. 1 Centers for Disease and Control, Injury Prevention and Control. WISQUARS leading cause of death visualization tool. Available at: https://wisqars.cdc.gov/data/lcd/home Google Scholar Traumatic brain injury remains the greatest cause of traumatic death, however hemorrhage is considered the leading reason for preventable death from trauma with a fatality rate reaching 40%. 2 Owattanapanich N Chittawatanarat K Benyakorn T Sirikun J Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: A meta-analysis. Scand J Trauma Resusc Emerg Med. 2018; 26 (Published 2018 Dec 17): 107https://doi.org/10.1186/s13049-018-0572-4 Crossref PubMed Scopus (36) Google Scholar Significant advances have been made over the last decades to reduce morbidity and mortality by shifting focus from treatment to stop the bleeding to that of rapid control of bleeding, establishing hemostasis, and stabilizing the patient until more definitive surgical treatment can be performed and is more likely to be successful. The procedure known as damage control surgery (DCS) first described in 1993 by Rotondo and et al 3 Rotondo MF Schwab CW McGonigal MD et al. “Damage control”: An approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993; 35: 375-383 Crossref PubMed Scopus (1205) Google Scholar focuses on three principles: (1) Surgical control of hemorrhage and contamination with packing to establish hemostasis; (2) Effective resuscitation to reverse coagulopathies and acidosis, and stabilize the patient; and (3) Definitive surgical management when the patient is more stable. 3 Rotondo MF Schwab CW McGonigal MD et al. “Damage control”: An approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993; 35: 375-383 Crossref PubMed Scopus (1205) Google Scholar , 4 Godat L Kobayashi L Costantini T Coimbra R Abdominal damage control surgery and reconstruction: World society of emergency surgery position paper. World J Emerg Surg. 2013; 8 (Published 2013 Dec 17): 53https://doi.org/10.1186/1749-7922-8-53 Crossref PubMed Scopus (69) Google Scholar , 5 Samuels JM Moore HB Moore EE Damage control resuscitation. Chirurgia (Bucur). 2017; 112: 514-523https://doi.org/10.21614/chirurgia.112.5.514 Crossref PubMed Scopus (17) Google Scholar DCS is predominately employed with patients who have major abdominal and thoracic injury, significant pelvic trauma, and/or multiple long bone fractures. 5 Samuels JM Moore HB Moore EE Damage control resuscitation. Chirurgia (Bucur). 2017; 112: 514-523https://doi.org/10.21614/chirurgia.112.5.514 Crossref PubMed Scopus (17) Google Scholar ,6 Ordoñez CA Parra MW Serna JJ et al. Damage control resuscitation: REBOA as the new fourth pillar. Colomb Med (Cali). 2020; 51 (Published 2020 Dec 30)e4014353https://doi.org/10.25100/cm.v51i4.4353 Crossref Scopus (12) Google Scholar