Uncontrolled bleeding in patients with major abdominal trauma

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Critical Care

Background:

• Severe abdominal injuries often lead to hemodynamic instability.
• Trauma-induced coagulopathy and uncontrolled bleeding are significant challenges.
• Existing guidelines emphasize reduced investigation time and limited fluid replacement before surgery.

Purpose of the Study:

• To introduce and evaluate the Damage Control Resuscitation (DCR) protocol.
• To prevent the lethal triad of hypothermia, acidosis, and coagulopathy in trauma patients.
• To optimize resuscitation and hemostasis strategies for severe abdominal trauma.

Main Methods:

• Implementing permissive hypotension with a target systolic pressure below physiological limits.
• Utilizing hemostatic resuscitation with blood components (PRBCs, plasma) in a 1:1 ratio.
• Employing Damage Control Surgery (DCS) techniques including packing, diversion, and temporary closure.

Main Results:

• The DCR protocol, including permissive hypotension and 1:1 PRBCs to plasma ratio, is linked to improved survival.
• Military protocols suggest massive transfusion triggers and specific component ratios (1:1:1) for better outcomes.
• Maintaining permissive hypotension (70-80 mmHg PAS) with limited crystalloids reduced mortality from 65% to 19% and decreased Abdominal Compartment Syndrome incidence.

Conclusions:

• Damage Control Resuscitation is a vital strategy for managing hemodynamically unstable patients with severe abdominal trauma.
• Permissive hypotension and hemostatic resuscitation are key components for preventing the lethal triad and improving survival.
• Damage Control Surgery combined with optimized resuscitation protocols significantly reduces mortality and complications.