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Damage control: Concept and implementation.

B Malgras1, B Prunet2, X Lesaffre3

  • 1Service de chirurgie viscérale, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France.

Journal of Visceral Surgery
|October 23, 2017
PubMed
Summary
This summary is machine-generated.

Damage control (DC) is a sequential strategy prioritizing physiological restoration for hemorrhagic trauma. This approach, including damage control surgery (DCS) and resuscitation (DCR), improves survival rates in severely injured patients.

Keywords:
CoagulopathyDamage controlDamage control resuscitationDamage control surgeryLethal triadRemote damage control resuscitationTraumatic hemorrhagic shock

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Area of Science:

  • Trauma Surgery
  • Critical Care Medicine
  • Emergency Medicine

Background:

  • Hemorrhagic trauma necessitates a shift from immediate anatomical repair to physiological stabilization.
  • Damage control (DC) principles were developed to manage severely injured patients, particularly in wartime scenarios.
  • The lethal triad of hypothermia, acidosis, and coagulopathy is a critical challenge in traumatic hemorrhagic shock.

Purpose of the Study:

  • To elucidate the evolution and components of the damage control (DC) concept in managing acute hemorrhagic trauma.
  • To describe the integrated approach of damage control resuscitation (DCR) and damage control surgery (DCS).
  • To highlight the expanding applications of DC principles, including remote DCR (RDCR) and radiological DC (DCRad).

Main Methods:

  • The study reviews the sequential therapeutic strategy of DC, encompassing surgical and intensive care interventions.
  • It details the three-step process of damage control surgery (DCS): hemostasis, physiological restoration, and definitive repair.
  • The integration of resuscitation modalities (DCR) with surgical interventions (DCS) is examined.

Main Results:

  • Damage control resuscitation (DCR) focuses on specific hemodynamic targets and early hemostasis to correct the lethal triad.
  • An integrated DCR-DCS approach allows for simultaneous resuscitation and surgical management, improving patient physiology without delaying surgery.
  • The DC concept has evolved to include remote DCR (RDCR) and radiological DC (DCRad) for broader application.

Conclusions:

  • Damage control (DC) strategies, including DCS and DCR, are crucial for improving survival in patients with severe hemorrhagic trauma.
  • The judicious application of DCS is essential, as universal use may lead to increased morbidity in less severely injured patients.
  • The ongoing evolution of DC principles emphasizes early hemorrhage control and hemostatic resuscitation for optimal patient outcomes.