J Korean Med Assoc.
2024 Dec;67(12):737-742. 10.5124/jkma.2024.67.12.737.
Damage control resuscitation for patients with bleeding trauma
- Affiliations
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- 1Department of Trauma Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
- KMID: 2563309
- DOI: http://doi.org/10.5124/jkma.2024.67.12.737
Abstract
- Background
Hemorrhagic trauma is a major preventable cause of mortality in critically injured patients. Rapid surgical interventions are essential for hemostasis. Comprehensive critical care management before and after surgery significantly enhances the patient survival. Damage control resuscitation (DCR) concept has been adapted from the damage control method of the United States Navy, which outlines immediate temporary measures to prevent a ship from sinking, followed by the definitive repair of the ship at a dock.
Current Concepts
DCR combined with damage control surgery focuses on controlling life-threatening hemorrhages and preventing trauma-induced coagulopathy. Key aspects of this strategy are: (1) Permissive hypotension (avoiding excessive fluid resuscitation to reduce re-bleeding risk), (2) restricted fluid and hemostatic resuscitation (limiting fluids and using blood products to promote coagulation), (3) use of antifibrinolytics (administering tranexamic acid to inhibit fibrinolysis and stabilize clots), (4) hypothermia prevention (maintaining normothermia to promote coagulation and mitigate acidosis), (5) calcium maintenance (maintaining normal calcium levels for proper cardiac function and coagulation), and (6) use of vasopressors (for stabilizing blood pressure and tissue perfusion). By integrating these aspects, DCR effectively controls immediate bleeding and overcomes systemic physiological challenges, thereby improving the survival of patients with severe trauma.
Discussion and Conclusion
Implementation of DCR with surgical interventions as a bundle of care effectively manages hemorrhagic trauma, possibly saving the patient. Therefore, DCR is a cornerstone strategy to improve the survival of patients with hemorrhagic trauma.
