Damage control resuscitation dcr represents the natural evolution of the initial concept of damage control surgery. Indeed, despite the use of damage control techniques, the mortality from trauma induced coagulopathy has not changed significantly over the past 30 years. In the beginning, damage control surgery was described by the three main steps. Damage control resuscitation gw school of medicine. Hemorrhage accounts for 30% to 40% of trauma fatalities and is the leading cause of preventable death in trauma. Hemorrhage is the leading cause of preventable death on the battlefield. Clinical practice guidelines cpgs clinical practice guidelines cpgs are the backbone of the systemwide jts performance improvement program. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients. Kim y, lee k, kim j, kim j, heo y, wang h, lee k, jung k.
This manual is also for those who are required to plan for the treatment of severely injured children so. In order to support this goal, the system must provide components at an appropriate ratio throughout the resuscitation process. Tranexamic acid tranexamic acid txa, an antifibrinolytic agent, has. Damage control resuscitation for patients with major trauma. In particular, plasmabased resuscitation with decreased volumes of crystalloids and artificial colloids as part of damage control resuscitation has improved outcomes in the military and civilian sectors. Damage control resuscitation dcr is a strategy for resuscitating patients from. Pdf damage control resuscitation for patients with major trauma.
Damage control resuscitation military medicine oxford. Damage control resuscitation and surgery with intensive care surgery ward care, rehabilitation psychosocial support the pages are designed to be copied on a phone camera. The development and maturation of tactical combat casualty care tccc is an important example of a critical process improvement strategy that reduced mortality in highthreat combatrelated trauma. Tranexamic acid tranexamic acid txa, an antifibrinolytic agent, has been used to decrease bleeding and. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Fig 2 the components of damage control resuscitation.
Damage control resuscitation transfusion guidelines. Damage control resuscitation dcr with concomitant mechanical hemorrhage control has become the preferred inhospital treatment of hemorrhagic shock. Welcome to part 2 of damage control resuscitation in the nontrauma center. Damage control resuscitation dcr is a strategy that seeks to prevent or mitigate hypothermia, acidosis, and coagulopathy through combined treatment paradigms. Combat operations necessitate bold thought and afford the opportunity to rapidly evolve and improve trauma care. The major principle of damage control resuscitation is to prevent development of coagulopathy by dilution of factors needed to provide hemostasis. Trauma center practice management guideline iowa methodist medical center des moines damage control orthopaedic surgery. Pdf damage control resuscitation dcr is a strategy for resuscitating patients from hemorrhagic shock to rapidly restore homeostasis. Damage control resuscitation dcr a summary of the joint. Atls 10th edition offers new insights into managing trauma. Damage control surgery is a surgical strategy aimed at restoring normal physiology rather than anatomical integrity.
A paradigm shift in the management of haemorrhagic shock find, read and cite all the research you. Holcomb, mdb introduction hemorrhage is a top cause of death after injury and is the leading cause of potentially preventable trauma deaths. Remote damage control resuscitation austererural environment patients modified transfusion strategy different than those with sceneprehospital time pdf on sep 1, 2008, sandy zalstein and others published damage control resuscitation. Cambridge damage control symposium prehospital research. Permissive hypotension the concept behind permissive hypotension involves keeping the blood pressure low enough to avoid exsanguinasubmitted for publication december 22, 2008. The cambridge damage control symposium was held in the mohammed bin rashid academic medical center in dubai healthcare city on the 24 th november 2014. Traumatic injury is the leading cause of death in under 45s most victims are young males most preventable deaths are due to haemorrhage leading preventable cause of death in. Request pdf the damage control resuscitation concept damage control is a strategy of care for bleeding trauma patients, involving minimal rescue surgery associated to perioperative resuscitation. Damage control resuscitation military medicine oxford academic. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. Damage control resuscitation in patients with severe. Damage control resuscitation comprises early hemorrhage control, hypotensive resuscitation permissive hypotension, hemostatic resuscitation. Achieving this goal quickly in the or may ultimately allow a shift from limited damage control surgery to earlier aggressive surgical interventions, including sophisticated limb salvage techniques and improved.
Direct peritoneal resuscitation accelerates primary abdominal. Joint trauma system clinical practice guideline jts cpg damage control resuscitation cpg id. Damage control resuscitation for pediatric trauma patients is defined as an attempt to limit the use of crystalloid resuscitation, as in adults. In this update, we focus on which patients need damage control resuscitation, current views on the optimal form of damage control resuscitation with blood products, the roles of newer blood products, and appropriate transfusion triggers in the postinjury setting.
Jason m samuels, hunter b moore, and ernest e moore. Damage control resuscitation for severe traumatic brain injury. Jan 20, 2017 coagulopathy observed in trauma patients was thought to be a resuscitation associated phenomenon. The use of prehospital blood products in the resuscitation of. The damage control resuscitation concept request pdf. Health data abstracted from patient records and after action reports is analyzed and distilled into globally relevant cpgs to remove medical practice variations and prevent needless deaths. A practice management guideline from the eastern association for the surgery of trauma. Ann of surg 2014 in 2010 trauma was leading cause of death for americans under 47 years old. Professor and vice chair director, center for translational injury research university of texas health sciences center houston.
Damage control resuscitation of the exsanguinating trauma patient. Additionally, we will provide an overview of our regional trauma systems use of. Although damage control surgery and resuscitation was initially described following abdominal injury, the basic principle has been extended to all aspects of trauma care. Application of damage control resuscitation strategies to patients with severe traumatic hemorrhage. Bradley m1, galvagno s, dhanda a, rodriguez c, lauerman m, dubose j, scalea t, stein d. The sequential strategy of operation followed by resuscitation has been replaced by an integrated approach so. The committee for tactical emergency casualty care ctecc adapted the. It currently includes early blood product transfusion, immediate arrest andor temporization of ongoing hemorrhage i. Trauma center practice management guideline iowa methodist. Unanswered questions in the use of blood component therapy. Review of fluid therapy in acute blood loss michele l. Evidence for damage control resuscitation is lacking the bmj. Damage control resuscitation with concomitant mechanical hemorrhage control has become the preferred inhospital treatment of hemorrhagic shock. The recommendation for the site for needle decompression of the chest continues to be the second intercostal space midclavicular line in this new edition.
Optimal fluid therapy for traumatic hemorrhagic shock. Damage control resuscitation protocol and the management of open abdomens in trauma patients. Efforts are focused on blood product transfusion with whole blood or component therapy closely approximating whole blood, limited use of crystalloid to avoid dilutional coagulopathy, hypotensive resuscitation until bleeding control is achieved, empiric. Definitive control of bleeding is the principal objective in any comprehensive resuscitation scheme for hemorrhagic shock, and therefore dcr must not eclipse emergent endoscopic, surgical or angiographic intervention. Tdcr is the active medical management of a patient in hemorrhagic shock in the combat environment. Chapter 5 i damage control surgery and resuscitation management of limb injuries during disasters and conflicts the principles of damage control surgery and resuscitationlisted below are of tantamount importance for the care of the patientwho is hypothermic, coagulopathic, acidotic, and resistant to fluidresuscitation. Joint theater trauma system clinical practice guideline guideline onlynot a substitute for clinical judgment august 2011 page 4 of 25 damage control resuscitation at level iibiii treatment facilities 5. Resuscitation strategies used in treating severely injured trauma patients have changed dramatically over the last 20 years. Much of the evidence for permissive hypotension has been extrapolated from animal studies.
By repeated point of care testing, commercial warming devices and the use of multiple blood products and fda. Damage control resuscitation as a structured intervention currently begins immediately after rapid initial assessment in the emergency department and progresses through the or into the icu. Damage control resuscitation journal of intensive care biomed. Damage control resuscitation dcr is a systematic approach to major exsanguinating trauma that modifies current initial resuscitation algorithms and early management protocols. Concepts in damage control resuscitation courtney sommer, md mph duke trauma symposium march 12, 2015 obligatory traumatologist slide 2 rhee et al. Damage control resuscitation dcr is a strategy for resuscitating patients from hemorrhagic shock to rapidly restore homeostasis. It is consistent with and encapsulates the established concept of damage control surgery dcs. Whenever cellular oxygen demand outweighs supply, both the cell and the organism are in a state of shock. Part 2 discusses several key considerations in the evaluation and management of the sick trauma patient. Contributors ltcp andrew p cap, mc, usa heather f pidcoke, md, phd.
Eamon raith 2, aprof william m griggs 3 mbbs, mba, pgdipavmed, fanzca, fcicm, facap, faicd, am, asm introduction damage control resuscitation dcr is a systematic approach to major exsanguinating trauma that. Twenty years ago, damage control surgery dcs was implemented to challenge the coagulopathy of trauma. Joint theater trauma system clinical practice guideline. Damage control resuscitation in patients with severe traumatic hemorrhage. Damage control surgery that prioritizes resuscitation and correction of metabolic derangements, coagulopathy, hypothermia, andor resolution of soft tissue injuries over early definitive surgical repair. If peripheral access is difficult due to shocked state insertion of rapid infusion catheters ric. Although the largest human study cited by the authors suggested some benefit from a dcr strategy, there were. Damage control surgery is a staged approach to the trauma patient in extremis that improves. Remote damage control resuscitation austererural environment patients modified transfusion strategy different than those with sceneprehospital time patient. The use of prehospital blood products in the resuscitation. Recent advances in our approach to blood component therapy in traumatic hemorrhage have resulted in a reassessment of many of the tenants of management which were considered standards of therapy for many years.
Principles of damage control resuscitation dr kav senasinghe cme march 2016, scgh ed 2. The damage control resuscitation dcr group would like to cordially invite you to the first international dcr congress wit h cosponsorship from thor and evtm societies. The purpose of this international group is to meet annually and establish international consensus guidelines on all aspects of damage control resuscitation. Damage control resuscitation dcr works synergistically with damage control surgery dcs and prioritizes nonsurgical interventions that reduce morbidity and mortality due to trauma and hemorrhage. Damage control resuscitation describes an approach to the early care of very seriously injured patients. Addition of a prehospital initial evaluation stage ground zero and separation of definitive. Haemorrhagic shock hemorrhagic shock is a condition of reduced tissue perfusion, resulting in the inadequate delivery of oxygen and nutrients that are necessary for cellular function. I was kindly sent by national ambulance llc as a member of their clinical education team, and they have allowed me to produce this report for both staff of national ambulance and for the foam community. The optimal strategy for managing hemorrhaging trauma patients is now termed damage control resuscitation dcr. Pdf the early recognition and management of hemorrhage shock are. In orthopedic surgery, the focus of damage control surgery is often to control hemorrhage, decrease contamination through debridement, and. Remote damage control resuscitation in austere environments. Damage control resuscitation of the sick trauma patient at.
Direct peritoneal resuscitation accelerates primary. Damage control resuscitation in patients with severe traumat. Keywords trauma massive transfusion mt acute traumatic coagulopathy atc transfusion ratio goal directed coagulation management damage control. In particular, plasmabased resuscitation with decreased volumes of crystalloids and artificial colloids as part of dcr has improved outcomes in the military and civilian sectors. Optimal fluid therapy for traumatic hemorrhagic shock ronald chang, mda, john b. Damage control resuscitation protocol and the management of. Damage control resuscitation is a resuscitation modality that integrates permissive hypotension, hemostatic resuscitation, and damage control surgery, initially addressing all three components of. Translating tactical combat casualty care lessons learned. Damage control resuscitation should be rapidly commenced. Damage control resuscitation dcr is a novel concept that draws together a series of technical and organisational advances in combat casualty care. Damage control resuscitation joint trauma system army. Clinical practice guidelines cpgs joint trauma system. Damage control surgery is a staged approach to the trauma patient in extremis.