Is it time to reframe resuscitation in trauma?

Area of Science:

• Traumatology
• Resuscitation Medicine
• Critical Care

Background:

• Trauma is a leading cause of death and disability.
• Non-compressible torso hemorrhage significantly contributes to trauma mortality.
• Current trauma management emphasizes damage control resuscitation, including permissive hypotension.

Purpose of the Study:

• To question the reliance on arbitrary systolic blood pressure targets in trauma resuscitation.
• To propose considering diastolic blood pressure in managing bleeding trauma patients.
• To advocate for a physiological approach to trauma resuscitation.

Main Methods:

• Review of current trauma resuscitation strategies.
• Analysis of the physiological role of diastolic blood pressure.
• Discussion of evidence supporting permissive hypotension versus other treatments.

Main Results:

• Evidence for permissive hypotension is less robust than for treatments like tranexamic acid.
• Clinicians often use arbitrary systolic blood pressure cutoffs.
• Diastolic blood pressure is crucial for coronary perfusion and cardiac output.

Conclusions:

• Rethinking trauma resuscitation to include diastolic blood pressure monitoring is suggested.
• Focusing on diastolic pressure may enhance coronary and cerebral perfusion.
• A physiological approach can lead to more nuanced and effective trauma treatment strategies.