Damage control resuscitation from major haemorrhage in polytrauma

General Review
  • 1k Downloads

Abstract

Trauma is a global disease that affects patients across the socio-economic spectrum. Uncontrolled major haemorrhage occurs from both blunt and penetrating trauma which may lead to hypovolaemic shock and ultimately death. In polytrauma patients that require urgent resuscitation secondary to major haemorrhage, high volume fluid infusions followed by definitive surgical care have been superseded by damage control resuscitation. DCR is a systematic approach to major trauma that integrates the principles of haemostatic resuscitation, permissive hypotension and damage control surgery (DCS). The aim of DCR is to aggressively minimise hypovolaemic shock and limit the development of coagulopathy, hypothermia and acidosis known as the lethal triad. Besides increased volumes of scientific knowledge to underpin modern trauma resuscitation techniques upon, patient survival is also dependent upon effective teamwork and leadership. In conclusion, successful resuscitation from major haemorrhage depends upon a variety of factors distilled into a trauma team with effective leadership, excellent technical and non-technical team skills as well as the early initiation of DCR.

Keywords

Damage control resuscitation Major haemorrhage Haemostatic resuscitation Permissive hypotension Coagulopathy 

References

  1. 1.
    West JG, Trunkey DD, Lim RC (1995) Systems of trauma care: a study of two counties. Clin Orthop Relat Res 318:4PubMedGoogle Scholar
  2. 2.
    Cotton BA et al. (2006) The cellular, metabolic, and systemic consequences of aggressive fluid resuscitation strategies. Shock 296(6632):1305–1308Google Scholar
  3. 3.
    Roberts I et al (2005) Trauma care research and the war on uncertainty. BMJ 331(7525):1094–1096PubMedCrossRefGoogle Scholar
  4. 4.
    Chesnut RMR et al (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34(2):216–222PubMedCrossRefGoogle Scholar
  5. 5.
    Harris T, Thomas GOR, Brohi K (2012) Early fluid resuscitation in severe trauma. BMJ 345(2):e5752–e5752PubMedCrossRefGoogle Scholar
  6. 6.
    Hodgetts TJ, Mahoney PF (2007) Damage control resuscitation. J Royal 34(2):216–222Google Scholar
  7. 7.
    Jansen JO et al (2009) Damage control resuscitation for patients with major trauma. BMJ(Abstr) 338:b1778Google Scholar
  8. 8.
    Moore EE (1996) Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome. Am J Surg (2):115–121Google Scholar
  9. 9.
    Brohi K et al (2003) Acute traumatic coagulopathy. J Trauma 54(6):1127–1130PubMedCrossRefGoogle Scholar
  10. 10.
    Holcomb JB et al (2007) Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 62(2):307–310PubMedCrossRefGoogle Scholar
  11. 11.
    Dawes R, Thomas GOR (2009) Battlefield resuscitation. Curr Opin in Crit Care 15(6):527–535CrossRefGoogle Scholar
  12. 12.
    Cotton BA et al (2008) Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization. J Trauma 64(5):1177–1183PubMedCrossRefGoogle Scholar
  13. 13.
    Borgman MA, Spinella PC, Perkins JG (2007) The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 105(2):116–121Google Scholar
  14. 14.
    Duchesne JC et al (2008) Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? J Trauma 65(2):272–276 (discussion 276–278)PubMedCrossRefGoogle Scholar
  15. 15.
    Ozier Y et al. (2007) Management of bleeding following major trauma: a European guideline. Crit Care 153(4):299–300Google Scholar
  16. 16.
    Williams-Johnson JA et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2) A randomised, placebo-controlled trial. West Indian Med J 59(6):612–624PubMedGoogle Scholar
  17. 17.
    Alam HB et al (2012) Hypothermia and hemostasis in severe trauma: a new crossroads workshop report. J Trauma Acute Care Surg 73(4):809–817PubMedCrossRefGoogle Scholar
  18. 18.
    Luna GK et al (1987) Incidence and effect of hypothermia in seriously injured patients. J Trauma 27(9):1014–1018PubMedCrossRefGoogle Scholar
  19. 19.
    Doufas AG (2003) Consequences of inadvertent perioperative hypothermia. Best Prac Res Clin Anaesthesiol 17(4):535–549CrossRefGoogle Scholar
  20. 20.
    Jurkovich GJ, Greiser WB, Luterman A (1987) Hypothermia in trauma victims: an ominous predictor of survival. J Trauma 28(Suppl 2):S241–S247Google Scholar
  21. 21.
    Fries D, Martini WZ (2010) Role of fibrinogen in trauma-induced coagulopathy. Br J Anaesth 105(2):116–121PubMedCrossRefGoogle Scholar
  22. 22.
    Lynn M et al (2002) Updates in the management of severe coagulopathy in trauma patients. Intensive Care Med 28(Suppl 2):S241–S247PubMedCrossRefGoogle Scholar
  23. 23.
    Regel G et al (1995) Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German level I trauma Center. J Trauma 38(1):70–78PubMedCrossRefGoogle Scholar
  24. 24.
    Strehlow MC (2010) Early identification of shock in critically ill patients. Emerg Med Clin N Am 38(1):70–78Google Scholar
  25. 25.
    Mapstone J, Roberts I, Evans P (2003) Fluid resuscitation strategies: a systematic review of animal trials. J Trauma 55(3):571–589PubMedCrossRefGoogle Scholar
  26. 26.
    Bickell WH et al (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Eng J Med 331(17):1105–1109CrossRefGoogle Scholar
  27. 27.
    Dutton RP, Mackenzie CF, Scalea TM (2002) Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma Acute Care Surg 52(6):1141CrossRefGoogle Scholar
  28. 28.
    Bowley DM, Barker P, Boffard KD (2000) Damage control surgery–concepts and practice. Central, J R Army Medical CorpsGoogle Scholar
  29. 29.
    Anderson ID et al (1988) Retrospective study of 1000 deaths from injury in England and Wales. BMJ Clin Res Ed 296(6632):1305–1308CrossRefGoogle Scholar
  30. 30.
    McCulloch P et al (2009) The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. Qual Saf Health Care 18(2):109–115PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Department of Trauma and OrthopaedicsWeston General HospitalWeston Super MareUK

Personalised recommendations