American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma: Clinical protocol for damage-control resuscitation for the adult trauma patient

Abstract

Damage control resuscitation in the care of critically injured trauma patients aims to limit blood loss and prevent and treat coagulopathy by combining early definitive hemorrhage control, hypotensive resuscitation and early and balanced use of blood products (hemostatic resuscitation) and the use of other hemostatic agents. This clinical protocol has been developed to provide evidence-based recommendations for optimal damage control resuscitation in the care of trauma patients with hemorrhage. LEVEL OF EVIDENCE Therapeutic/Care Management; Level V. TYPE: Algorithms / Guidelines / Clinical Protocol

Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

“…Life-threatening hemorrhage is a major preventable cause of early death after trauma [ 13 ]. Bleeding control with circulating blood volume restoration is a priority in polytrauma care and the main goal of damage control strategies [ 14 , 15 ]. Arterial hypotension and hypoxia are frequently observed after isolated tSCI, especially when the injury occurs at high spinal cord levels [ 1 ].…”

“…The most recent guidelines by the Congress of Neurological Surgeons (CNS) for managing tSCI patients recommend maintaining MAP between 85 and 90 mmHg for the first 7 days following an acute cervical SCI (Level III) [ 16 ]. These values are difficult to obtain in the acute phase management of bleeding polytrauma patients, also considering the worldwide increase in the utilization of permissive hypotension in the setting of damage control resuscitation [ 14 ]. Considering the above, we recommend the maintenance of a MAP > 85 mmHg during interventions for life-threatening hemorrhage or emergency spinal surgery.…”

“…Meanwhile, we recommend the early reversal of anticoagulant/antiplatelet agents in tSCI polytrauma patients needing interventions for life-threatening hemorrhage or emergency spinal surgery. Massive transfusion is frequently utilized in bleeding trauma patients [ 14 , 40 ]. The pragmatic randomized optimal platelet and plasma ratios (PROPPR) study, involving 680 trauma patients with major bleeding, was performed to determine the safety and the effectiveness of a transfusion strategy involving plasma, PLTs and RBCs in a 1:1:1 ratio compared with a 1:1:2 ratio.…”

“…However, patients in the 1:1:1 group achieved hemostasis with fewer deaths due to exsanguination within the first 24 hours [ 41 ]. Some of our panelists suggest, as an alternative to this strategy, the utilization of whole blood transfusion as indicated in a recently published clinical protocol for damage control resuscitation by the American Association for the Surgery of Trauma (AAST) and the American College of Surgeons Committee on Trauma (ACS-COT) [ 14 ]. No data are available regarding trauma coagulopathy and the progression of tSCI.…”

Damage Control Resuscitation: Evidence-based Systematic Review for Treating Traumatized Patients

“…The literature shows the three pillars of DCR are a well-established strategy, the first principle brings an approach to blood pressure management aimed at ensuring adequate perfusion of organs, avoiding exacerbation of bleeding. The strategy involves maintaining a "hypotensive" state with a target systolic blood pressure of 80 mmHg (or a mean arterial pressure of 80 mmHg in cases of neurotrauma) to minimize future blood loss and prevent displacement of blood clots [3][4][5][6][7]9,12]. Placing in a unanimous position among the reviewed authors and studies.…”