Damage Control Resuscitation.

Area of Science:

• Trauma Surgery and Critical Care

Background:

• Hemorrhagic shock requires rapid resuscitation to restore homeostasis.
• Damage control resuscitation (DCR) is a key strategy for managing severe bleeding.
• Identifying patients needing massive transfusion early is critical but challenging.

Purpose of the Study:

• To review the principles and indicators of damage control resuscitation.
• To highlight strategies for identifying patients at risk of massive transfusion.
• To discuss DCR in various settings, including out-of-hospital and in-hospital scenarios, and pediatric considerations.

Main Methods:

• Review of DCR strategies focusing on blood product transfusion, limited crystalloid, hypotensive resuscitation, tranexamic acid, and temperature/pH management.
• Identification of clinical and laboratory indicators for massive transfusion.
• Discussion of DCR application in diverse pre-hospital and military medical treatment facilities.

Main Results:

• Key DCR components include whole blood or component therapy, minimal crystalloids, permissive hypotension, tranexamic acid, and temperature/pH control.
• Indicators for massive transfusion include SBP <110 mmHg, HR >105 bpm, Hct <32%, pH <7.25, specific injury patterns, positive FAST scans, elevated lactate, and elevated INR.
• Out-of-hospital and in-hospital DCR protocols are adapted for different care environments.

Conclusions:

• Damage control resuscitation is essential for managing exsanguinating trauma patients.
• Utilizing specific clinical and laboratory markers aids in the early identification of massive transfusion needs.
• Tailored DCR approaches are necessary for different operational and patient populations.