Damage control resuscitation for patients with major trauma

Jansen, Jan O.; Thomas, Rhys; Loudon, Malcolm; Brooks, Adam

doi:10.1136/bmj.b1778

Cited by 192 publications

(142 citation statements)

References 118 publications

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“…DCS is now incorporated as a component of DCR and should not be practiced in isolation [64]. DCR as a structured intervention should begin immediately after rapid initial assessment in the emergency room and progresses through the operating theater into the ICU in combination with DCS [48].…”

Section: Changes Of Surgical Strategy In Dcrmentioning

confidence: 99%

“…In addition, contractility of the heart and systemic vascular resistance are diminished under decreased ionized calcium levels. Because of its combined beneficial cardiovascular and coagulation effects, the calcium concentration should be monitored periodically with every ten units of transfusion, and it is recommended that a concentration of at least 0.9 mmol/L be maintained [64,65].…”

Section: Calciummentioning

confidence: 99%

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Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Mizobata

2017

j intensive care

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Coagulopathy observed in trauma patients was thought to be a resuscitation-associated phenomenon. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. It consists of three steps: abbreviated surgery to control the hemorrhage and contamination, resuscitation in the intensive care unit (ICU), and planned re-operation with definitive surgery. The resuscitation strategy of DCS focused on the rapid reversal of acidosis and prevention of hypothermia through the first two steps. However, direct treatment of coagulopathy was not emphasized in DCS. Recently, better understanding of the pathophysiology of coagulopathy in trauma patients has led to the logical opinion that we should directly address this coagulopathy during major trauma resuscitation. Damage control resuscitation (DCR), the strategic approach to the trauma patient who presents in extremis, consists of balanced resuscitation, hemostatic resuscitation, and prevention of acidosis, hypothermia, and hypocalcemia. In balanced resuscitation, fluid administration is restricted and hypotension is allowed until definitive hemostatic measures begin. The administration of blood products consisting of fresh frozen plasma, packed red blood cells, and platelets, the ratio of which resembles whole blood, is recommended early in the resuscitation. DCR strategy is now the most beneficial measure available to address trauma-induced coagulopathy, and it can change the treatment strategy of trauma patients. DCS is now incorporated as a component of DCR. DCR as a structured intervention begins immediately after rapid initial assessment in the emergency room and progresses through the operating theater into the ICU in combination with DCS. By starting from ground zero with the performance of DCS, DCR allows the trauma surgeon to correct the coagulopathy of trauma. The effect of the reversal of coagulopathy in massively hemorrhagic patients may change the operative strategy with DCS.

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Section: Changes Of Surgical Strategy In Dcrmentioning

confidence: 99%

Section: Calciummentioning

confidence: 99%

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Mizobata

2017

j intensive care

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“…Subsequently, following the implementation of the DCo, the patient is transferred to Intensive Care Unit where the main goal is to restore severely abnormal physiology of the patient by aggressively addressing all three components of the lethal triad: hypothermia, acidosis and coagulopathy (7,9). This ultimately enables definitive surgery without compromising the patient's physiological status and exacerbating the inflammation cascade.…”

Section: Intensive Care Unitmentioning

confidence: 99%

Lower Limb Trauma: Limb Salvage or an Early Amputation?

Kaczynski

Dillon²,

Hilton³

2012

Polish Journal of Surgery

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“…Plasma fibrinogen reached the lowest value at the earlier phase than other coagulation factor parameters and low fibrinogen value is one of the signs of deficiency of clotting factors primary in the case of trauma with major bleeding. [9][10][11][12][13][14][15] Management of bleeding due to trauma requires the existence of a rapid identification TIC so that it can become the basis for replacement therapy.…”

Section: Introductionmentioning

confidence: 99%

Relationship between initial fibrinogen level with coagulopathy and mortality in multiple trauma patients

2017

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Background: In trauma induced coagulopathy (TIC), low fibrinogen value is often found and plasma fibrinogen reached low value earlier than other parameters of coagulation factors. Initial fibrinogen value is strongly correlated to the injury severity score (ISS) and be an independent predictor of mortality. This study was expected to see the relationship between initial fibrinogen level with coagulopathy and mortality, so it can predict early coagulopathy and can prevent bleeding complications that lead to mortality. Methods: The study was conducted prospectively. The entire examination obtained from patients with multiple trauma. Fibrinogen levels and coagulopathy were taken from the blood laboratory tests in conjunction with other routine examination when patients were admitted to the ER of Hasan Sadikin General Hospital. Outcome parameters were the incidence of coagulopathy and mortality. Statistical analyses were performed to look at the significance of relationships.Results: Of the 25 patients with multiple trauma obtained a majority of 80% were male patients and with the highest incidence mechanism was head trauma as many as 16 people (64%). There were 8 patients (32%) experienced coagulopathy and mortality occurred in 7 patients (28%). Chi square analysis found a significant association between fibrinogen and coagulopathy (p = 0.043), while the association between initial fibrinogen with mortality was not significant (p = 0.341).Conclusions: Initial fibrinogen level is significantly associated with coagulopathy but it cannot predict mortality in patients with multiple trauma. Further study is needed in order to assess the benefit of these results on the management of multiple trauma patients.

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Damage control resuscitation for patients with major trauma

Cited by 192 publications

References 118 publications

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Lower Limb Trauma: Limb Salvage or an Early Amputation?

Relationship between initial fibrinogen level with coagulopathy and mortality in multiple trauma patients

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