Damage Control Resuscitation.
Resuscitation of the hemorrhaging patient has undergone significant changes in the last decade resulting in the concept of damage control resuscitation (DCR). Hemostatic resuscitation aims to address the physiologic derangements found in the hemorrhaging patient, namely coagulopathy, acidosis, and hypothermia. Strategies to achieve this are permissive hypotension, high ratio of plasma and platelet transfusion to packed red blood cell transfusion, and limitation of crystalloid administration. Damage control surgery aims for early hemorrhage control and minimizing operative time by delaying definitive repair until the patient's physiologic status has normalized. Together these strategies constitute DCR and have led to improved outcomes for hemorrhaging patients over the last 2 decades. Recently, DCR has been augmented by both pharmacologic and laboratory adjuncts to improve the care of the hemorrhaging patient. These include thrombelastography as a detailed measure of the clotting cascade, tranexamic acid as an antifibrinolytic, and the procoagulant activated factor VII. In this review, we discuss the strategies that makeup DCR, their adjuncts, and how they fit into the care of the hemorrhaging patient.
Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
James N
JN
Bogert
Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
John A
JA
Harvin
Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA bryan.a.cotton@uth.tmc.edu.
Bryan A
BA
Cotton
D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D001803:Blood Transfusion; D002985:Clinical Protocols; D000077324:Crystalloid Solutions; D015942:Factor VIIa / Q000008:administration & dosage; D005440:Fluid Therapy; D006470:Hemorrhage / Q000628:therapy*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods / Q000639:trends; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy*; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000008:administration & dosage*; D014947:Wounds and Injuries / Q000150:complications* / Q000601:surgery
D000933:Antifibrinolytic Agents; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D014148:Tranexamic Acid; D015942:Factor VIIa
damage control; hemorrhage; massive transfusion; resuscitation