title: Remote damage control resuscitation and the Solstrand Conference: defining the need, the language, and a way forward.
abstract: Damage control resuscitation (DCR) is emerging as a standard practice in civilian and military trauma care. Primary objectives include resolution of immediate life threats followed by optimization of physiological status in the perioperative period. To accomplish this, DCR employs a unique hypotensive-hemostatic resuscitation strategy that avoids traditional crystalloid intravenous fluids in favor of early blood component use in ratios mimicking whole blood. The presence of uncontrolled major hemorrhage (UMH) coupled with a delay in access to hemostatic surgical intervention remains a primary contributor to preventable death in both combat and in many domestic settings, including rural areas and disaster sites. As a result, civilian and military emergency care leaders throughout the world have sought a means to project DCR principles forward of the traditional trauma resuscitation bay, into such remote environments as disaster scenes, rural health facilities, and the contemporary battlefield. After reflecting on experiences from past conflicts, defining current capability gaps, and examining available and potential solutions, a strategy for "remote damage control resuscitation" (RDCR) has been proposed. In order for RDCR to progress from concept to clinical strategy, it will be necessary to define existing gaps in knowledge and clinical capability; develop a lexicon so that investigators and operators may understand each other; establish coherent research and development agendas; and execute comprehensive investigations designed to predict, diagnose, and mitigate the consequences of hemorrhagic shock and acute traumatic coagulopathy before they become irreversible. This article seeks to introduce the concept of RDCR; to reinforce the importance of identifying and optimally managing UMH and the resulting shock state as part of a comprehensive approach to out-of-hospital stabilization and en route care; and to propose investigational strategies to enable the development and broad implementation of RDCR principles.
authors.affiliation: US Army Institute of Surgical Research, Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas 78234, USA. robert.gerhardt@us.army.mil
authors.forename: Robert T
authors.initials: RT
authors.lastname: Gerhardt
authors.forename: Geir
authors.initials: G
authors.lastname: Strandenes
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Rentas
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
authors.forename: Jeff
authors.initials: J
authors.lastname: Mott
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dubick
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
mesh_terms: D016913:Blood Component Transfusion / Q000379:methods* / Q000639:trends; D003226:Congresses as Topic; D004189:Disaster Planning / Q000379:methods* / Q000639:trends; D006801:Humans; D008887:Military Medicine / Q000379:methods / Q000639:trends; D020380:Needs Assessment; D012151:Resuscitation / Q000379:methods* / Q000639:trends; D012771:Shock, Hemorrhagic / Q000628:therapy; D014947:Wounds and Injuries / Q000628:therapy*