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Related Experiment Video

Updated: Mar 11, 2026

Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
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Optimal Fluid Therapy for Traumatic Hemorrhagic Shock.

Ronald Chang1, John B Holcomb2

  • 1Center for Translational Injury Research, University of Texas Health Science Center, 6410 Fannin Street, Suite 1100, Houston, TX 77030, USA.

Critical Care Clinics
|November 30, 2016
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Summary

Damage control resuscitation (DCR) has transformed traumatic hemorrhagic shock treatment by prioritizing balanced blood products and minimizing fluids. However, accurately predicting which patients need DCR remains difficult.

Keywords:
Damage control resuscitationHemorrhagic shockMassive transfusion protocol

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Area of Science:

  • Trauma resuscitation
  • Hemorrhagic shock management
  • Blood product transfusion

Background:

  • Traumatic hemorrhagic shock management has evolved significantly over the past two decades.
  • Damage control resuscitation (DCR) represents a major paradigm shift in this field.
  • Key DCR principles include minimizing crystalloid, permissive hypotension, balanced blood product transfusion, and correcting coagulopathy.

Purpose of the Study:

  • To review the evolution and core components of damage control resuscitation for traumatic hemorrhagic shock.
  • To highlight the shift towards plasma as the primary volume expander.
  • To identify the persistent challenge in predicting the need for DCR and activating massive transfusion protocols.

Main Methods:

  • Review of current literature and clinical practices in trauma resuscitation.
  • Analysis of the principles and components of damage control resuscitation.
  • Discussion of the role of plasma versus crystalloid in volume expansion.
  • Identification of challenges in massive transfusion protocol activation.

Main Results:

  • Plasma has largely replaced crystalloid as the preferred initial volume expander in DCR for traumatic hemorrhagic shock.
  • DCR emphasizes a balanced approach to resuscitation, including blood products and coagulopathy correction.
  • Predicting the precise need for DCR and timely massive transfusion protocol activation remains a significant clinical challenge.

Conclusions:

  • Damage control resuscitation has fundamentally changed the approach to severe bleeding.
  • The optimal use of plasma and balanced transfusion strategies are central to DCR.
  • Improved methods for early identification of patients requiring DCR are crucial for improving outcomes.