Damage Control Resuscitation in Combination With Damage Control Laparotomy: A Survival Advantage

Duchesne, Juan; Kimonis, Katerina; Marr, Alan B.; Rennie, Kelly V.; Wahl, Georgia; Wells, Joel; Islam, Tareq; Meade, Peter; Stuke, Lance; Barbeau, J. Mills; Hunt, John P.; Baker, Christopher C.; McSwain, Norman E.

doi:10.1097/ta.0b013e3181df91fa

Cited by 175 publications

(105 citation statements)

References 18 publications

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“…Rewarming efforts, early correction of acidosis, and aggressive crystalloid resuscitation in patients requiring damage control surgery have been the prime tenets of a trauma resuscitation strategy. This focus on early correction of physiologic abnormalities has prompted the era of damage control surgery [17,20,23,[64][65][66][67][68]. However, improvement of clinical outcomes in patients requiring damage control surgery, even accompanied by aggressive correction of physiologic derangements, is still insufficient.…”

Section: Discussionmentioning

confidence: 99%

Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

2017

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Hemorrhage is the most important contributing factor of acute-phase mortality in trauma patients. Previously, traumatologists and investigators identified iatrogenic and resuscitation-associated causes of coagulopathic bleeding after traumatic injury, including hypothermia, metabolic acidosis, and dilutional coagulopathy that were recognized as primary drivers of bleeding after trauma. However, the last 10 years has seen a widespread paradigm shift in the resuscitation of critically injured patients, and there has been a dramatic evolution in our understanding of trauma-induced coagulopathy. Although there is no consensus regarding a definition or an approach to the classification and naming of trauma-associated coagulation impairment, trauma itself and/or traumatic shockinduced endogenous coagulopathy are both referred to as acute traumatic coagulopathy (ATC), and multifactorial trauma-associated coagulation impairment, including ATC and resuscitation-associated coagulopathy is recognized as trauma-induced coagulopathy. Understanding the pathophysiology of trauma-induced coagulopathy is vitally important, especially with respect to the critical issue of establishing therapeutic strategies for the management of patients with severe trauma.

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Section: Discussionmentioning

confidence: 99%

Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

2017

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“…Recent studies have shown that early and aggressive transfusion of FFP and PC is associated with a higher survival rate among major trauma patients (16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

Survey of Poly Fibrinogen Levels in Patients With Major Blunt Trauma

et al. 2015

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Background: Coagulopathy is common after severe trauma or massive bleeding, and many studies have shown the benefits of coadministration of blood and plasma. Efforts are being made to improve the treatment of patients injured by blunt trauma using plasma infusion. Objectives: This study focused on blood fibrinogen levels in patients with severe trauma and bleeding. Patients and Methods: Twenty-eight patients who were admitted to the Rajaee (Emtiaz) Trauma Hospital were studied in this crosssectional survey, which was conducted in August and September of 2013. The patients were male and over 16 years old, with an injury severity score greater than or equal to 16, diastolic blood pressure under 90 mmHg, a minimum 1500 cc of estimated blood loss, and a minimum of 2000 cc crystalloid fluid intake, and patients were not receiving blood or blood products at the time of the traumatic event. Upon patient arrival, blood samples were obtained to measure fibrinogen concentration before starting resuscitation for the patient. Administration of blood and blood products was then performed according to hospital protocol. Results: Over three months, twenty eight patients were admitted with the above criteria. Among these patients, the fibrinogen levels of eight cases (28.57%) were reported as non-measurable. Fibrinogen levels in 10% of the patients were below the acceptable standard of admission to the center, which means that blood fibrinogen levels were lower than normal in a significant number of patients. Conclusions: Severe tissue damage and bleeding significantly reduce fibrinogen levels, and the positive effects of administering plasma to severe trauma patients may be due to the fibrinogen that plasma provides. It is therefore important to discover safer ways to administer fibrinogen. We recommend that the amount of administered fibrinogen be controlled, and that a thromboelastography be conducted for all patients on arrival.

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“…DCR restores this reserve, allowing more definitive treatment that results in decreased postoperative complications and improved outcomes [40,68].…”

Section: Changes Of Surgical Strategy In Dcrmentioning

confidence: 99%

“…Following the prediction of massive transfusion, blood products should be delivered in a quick and timely manner at a high ratio of plasma, RBCs, and platelets. To achieve this quick response, not only the resuscitation staff but also the blood bank staff need to incorporate pre-implemented guidelines and flow charts for massive transfusion protocol (MTP) into their work flow [48,[66][67][68]. The protocol includes patient selection for activation of the MTP, description of the staff who should declare the activation, and the means by which the resuscitation team and the blood bank are informed of the protocol's activation.…”

Section: Massive Transfusion Protocolmentioning

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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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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Damage Control Resuscitation in Combination With Damage Control Laparotomy: A Survival Advantage

Cited by 175 publications

References 18 publications

Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

Survey of Poly Fibrinogen Levels in Patients With Major Blunt Trauma

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

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