Short-Term Outcomes and Complications of Damage Control and Definitive Laparotomy in Deployed Combat Environments: 2002 to 2011

Mitchell, Thomas A.; Lauer, Cynthia L.; Aden, James K; Edwards, Kurt; Bailey, Jeffrey A.; White, Christopher E.; Blackbourne, Lorne H.; Holcomb, John B.

doi:10.7205/milmed-d-14-00726

Cited by 11 publications

(22 citation statements)

References 12 publications

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“…It has resulted in various injuries of military personnel, which is not typically seen in known armed conflicts [3–6]. Out of all injuries, thoraco-abdominal fragmental wounds are considered as the most severe [3, 7, 8]. First aid is provided during the evacuation or at the place of injury (I level), whereas hospital stage of medical care in Ukraine to the combat patients is organized at the levels II, III, IV, and V [7, 9].…”

Section: Introductionmentioning

confidence: 99%

“…Out of all injuries, thoraco-abdominal fragmental wounds are considered as the most severe [3, 7, 8]. First aid is provided during the evacuation or at the place of injury (I level), whereas hospital stage of medical care in Ukraine to the combat patients is organized at the levels II, III, IV, and V [7, 9]. The surgical care (II level) is provided in district hospitals to be deployed very close to the battlefield line, contributing to the implementation the principle of the “golden hour”.…”

Section: Introductionmentioning

confidence: 99%

“…Damage control (DC) is a clinical approach in combat conditions to be applied in the US army and military forces of NATO, and in some other armies to improve the management of combat patients [7, 10]. In brief, a DC is a combination of DC surgery and DC resuscitation aiming to control hemorrhage and microbial contamination followed by intraperitoneal or thoracic packing and rapid closure of wounds, resuscitations to correct fluid homeostasis, to control coagulopathy in the intensive care unit (ICU) as well as application of re-exploration [7, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

“…In brief, a DC is a combination of DC surgery and DC resuscitation aiming to control hemorrhage and microbial contamination followed by intraperitoneal or thoracic packing and rapid closure of wounds, resuscitations to correct fluid homeostasis, to control coagulopathy in the intensive care unit (ICU) as well as application of re-exploration [7, 11, 12]. …”

Section: Introductionmentioning

confidence: 99%

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Hydrodynamic rupture of liver in combat patient: a case of successful application of “damage control” tactic in area of the hybrid war in East Ukraine

Хоменко¹,

Шаповалов²,

Tsema

et al. 2017

surg case rep

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BackgroundThe hybrid war of Russia against Ukraine has been started in certain districts of Donetsk and Luhansk oblasts within the Donbas area in 2014.Case presentationWe report a clinical case of a combat patient who was injured after the multiple launcher rocket system “Grad” shelling, diagnosed with hydrodynamic liver rupture followed by medical management with application of damage control (DC) tactic in conditions of hybrid war.The patient underwent relaparatomy, liver resection, endoscopic papillosphincterotomy, endoscopic retrograde cholecystopancreatography, stenting of the common bile duct, and VAC-therapy. Applied treatment modalities were effective; the patient was discharged on the 49th day after injury.ConclusionsTo our best knowledge, this is the first report describing a successful application of DC tactic in the hybrid war in East Ukraine. From this case, we suggest that application of DC tactic at all levels of combat medical care could save more lives.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hydrodynamic rupture of liver in combat patient: a case of successful application of “damage control” tactic in area of the hybrid war in East Ukraine

Хоменко¹,

Шаповалов²,

Tsema

et al. 2017

surg case rep

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show abstract

“…Such a prospective randomised trial might be considered as a priority for the management of military combat casualties since more than 1000 laparotomies were performed during the most recent conflicts in Iraq and Afghanistan 4. Another example of a potential study might be a RCT of fibrinogen concentrate as an intervention during prehospital remote damage control resuscitation following combat injury.…”

mentioning

confidence: 99%

Towards research combat readiness: prepared, prospective and preapproved

Naumann

Eisenstein²,

Burns

et al. 2017

J R Army Med Corps

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Research drives the advancement of medical knowledge during war, but planning and execution are too slow to enable early data acquisition. Future conflicts are likely to be shorter and more dispersed, requiring innovation to avoid missing out on the crucial early stages. To seize the initiative, we suggest that a collection of preapproved research studies be designed, stored and maintained within the medical command structure so that they are ready for immediate implementation at the onset of future conflicts, even during the most kinetic early phases of deployment.

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Damage Control Laparotomy: High‐Volume Centers Display Similar Mortality Rates Despite Differences in Country Income Level

et al. 2020

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Background Comprehensive analysis of trauma care between high-, middle-, and low-income countries (HIC/MIC/ LIC) is needed to improve global health. Comparison of HIC and MIC outcomes after damage control laparotomy (DCL) for patients is unknown. We evaluated DCL utilization among patients treated at high-volume trauma centers in the USA and South Africa, an MIC, hypothesizing similar mortality outcomes despite differences in resources and setting. Methods Post hoc analysis of prospectively collected trauma databases from participating centers was performed. Injury severity, physiologic, operative data and post-operative outcomes were abstracted. Univariate and multivariable analyses were performed to assess differences between HIC/MIC for the primary outcome of mortality. Results There were 967 HIC and 602 MIC patients who underwent laparotomy. DCL occurred in 144 MIC patients (25%) and 241 HIC (24%) patients. Most sustained (58%) penetrating trauma with higher rates in the MIC compared to the HIC (71 vs. 32%, p = 0.001). Between groups, no differences were found for admission physiology, coagulopathy, or markers of shock except for increased presence of hypotension among patients in the HIC. Crystalloid infusion volumes were greater among MIC patients, and MIC patients received fewer blood products than those in the HIC. Overall mortality was 30% with similar rates between groups (29 in HIC vs. 33% in MIC, p = 0.4). On regression, base excess and penetrating injury were independent predictors of mortality but not patient residential status. Conclusion Use and survival of DCL for patients with severe abdominal trauma was similar between trauma centers in HIC and MIC settings despite increased penetrating trauma and less transfusion in the MIC center. While the results overall suggest no gap in care for patients requiring DCL in this MIC, it highlights improvements that can be made in damage control resuscitation.

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Short-Term Outcomes and Complications of Damage Control and Definitive Laparotomy in Deployed Combat Environments: 2002 to 2011

Abstract: In conclusion, excluding deaths with the first 24 hours, DCL and DL had comparable mortality and complication rates at NATO Roles 2 and 3 MTFs.

Cited by 11 publications

References 12 publications

Hydrodynamic rupture of liver in combat patient: a case of successful application of “damage control” tactic in area of the hybrid war in East Ukraine

Hydrodynamic rupture of liver in combat patient: a case of successful application of “damage control” tactic in area of the hybrid war in East Ukraine

Towards research combat readiness: prepared, prospective and preapproved

Damage Control Laparotomy: High‐Volume Centers Display Similar Mortality Rates Despite Differences in Country Income Level

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