Prehospital care according to the principles of Damage Control Resuscitation in the conditions of modern warfare (literature review)

Abstract

Relevance. Bleeding and hemorrhagic shock are the leading cause of potentially preventable deaths in combat casualties. The concept of pre-hospital injury control Remote Damage Control Resuscitation is becoming an integral part of care in the wounded with shock in the field. The significance of prehospital care provision according to the principles of Damage Control Resuscitation is increasing in future “multidomain battlefield”.The objective is to consider the effectiveness and features of prehospital care provision according to the principles of DCR in armed conflicts of the last two decades (in Afghanistan, Iraq, Africa, the Middle East).Methodology. A search was made for scientific articles in the PubMed database and the Scientific Electronic Library (eLIBRARY.ru), published from 2017 to 2022.Results and Discussion. Prehospital care according to the principles of Damage Control Resuscitation includes temporary arrest of bleeding, infusion therapy as part of hemostatic resuscitation and permissive hypotension, adequate respiratory support, prevention and elimination of hypothermia, and prompt evacuation to the stage of surgical care. Effective means to stop bleeding in combat casualties are modern hemostatic tourniquets, pelvic bandage, hemostatic dressings with koalin and chitosan. Resuscitation endovascular balloon occlusion of the aorta is recognized as a promising method for stopping internal bleeding. The basis of hemostatic resuscitation on the battlefield is the earlier transfusion of blood or its components in combination with the introduction of tranexamic acid and calcium preparations. Group O (I) whole blood with low titer anti-A and anti-B antibodies, lyophilized plasma and fibrinogen concentrate offer logistical advantages for combat use.Conclusion. Pre-hospital care according to the principles of Damage Control Resuscitation is effective and can significantly reduce mortality among those injured in combat operations.