Anesth Pain Med.  2024 Apr;19(2):73-84. 10.17085/apm.24038.

Revolutionizing trauma care: advancing coagulation management and damage control anesthesia

• Kwon MA
• Ji SM

• KMID: 2555244
• DOI: http://doi.org/10.17085/apm.24038

Abstract

Despite advances in emergency transfer systems and trauma medicine, the incidence of preventable deaths due to massive hemorrhage remains high. Recent immunological research has elucidated key mechanisms underlying trauma-induced coagulopathy in the early stages of trauma, including sympathoadrenal stimulation, shedding of the glycocalyx, and endotheliopathy. Consequently, the condition progresses to fibrinogen depletion, hyperfibrinolysis, and platelet dysfunction. Coexisting factors such as uncorrected acidosis, hypothermia, excessive crystalloid administration, and a history of anticoagulant use exacerbate coagulopathy. This study introduces damage-control anesthetic management based on recent insights into damage-control resuscitation, emphasizing the importance of rapid transport, timely bleeding control, early administration of antifibrinolytics and fibrinogen concentrates, and maintenance of calcium levels and body temperature. Additionally, this study discusses brain-protective strategies for trauma patients with brain injuries and the utilization of cartridge-based viscoelastic assays for goal-directed coagulation management in trauma settings. This comprehensive approach may provide potential insights for anesthetic management in the fast-paced field of trauma medicine.

Keyword

Anesthesia; Blood coagulation; Blood transfusion; Endothelium; Fibrinogen; Fibrinolysis; Glycocalyx; Multiple trauma; Traumatic brain injury

Figure

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  Fig. 1. Trauma induced coagulopathy. Reused from the article of Maegele et al. (Chin J Traumatol 2017; 20: 125-32) [47].

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  Fig. 2. Shock induced endotheliopathy and glycocalyx shedding. NMDA: N-Methyl-D-Aspartate, ROTEM: rotational thromboelastometry, TEG: thromboelastography, tPA: tissue plasminogen activator. Reused from the article of Bunch et al. (Front Physiol 2023; 14: 1094845) [13].

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