Resuscitation of subdiaphragmatic exsanguination

Subdiaphragmatic exsanguination is a major cause of death in civilian trauma. In a 1-year review of 867 consecutive admissions to a Level I Trauma Center, a 4.3 per cent incidence (37 patients) of infradiaphragmatic exsanguination was found. Eleven per cent of all abdominal injuries and 35 per cent of pelvic fractures sustained massive hemorrhage. A treatment protocol incorporating immediate airway control, MAST device, super-large bore venous access, warming rapid infusors, immediate type O blood transfusion, emergency department thoracotomy, and emergent operation as required, produced an overall mortality of 54 per cent. Mortality was higher for pelvic fracture (59%) than abdominal injury (43%). No patient survived ED thoracotomy. Continued developments in resuscitation techniques, as well as prehospital, and operative care are required to reduce mortality from exsanguinating hemorrhage.