Damage control resuscitation

Andrew P. Cap, Heather F. Pidcoke, Philip Spinella, Geir Strandenes, Matthew A. Borgman, Martin Schreiber, John Holcomb, Homer Chin Nan Tien, Andrew N. Beckett, Heidi Doughty, Tom Woolley, Joseph Rappold, Kevin Ward, Michael Reade, Nicolas Prat, French Army, Sylvain Ausset, Bijan Kheirabadi, Avi Benov, Maj Edward P. Griffin & 6 others Jason B. Corley, Clayton D. Simon, Roland Fahie, Donald Jenkins, Brian J. Eastridge, Zsolt Stockinger

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Damage control resuscitation (DCR) is a strategy for resuscitating patients from hemorrhagic shock to rapidly restore homeostasis. 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 use of tranexamic acid, prevention of acidosis and hypothermia, and rapid definitive surgical control of bleeding. Patients receiving uncrossmatched Type O blood in the emergency department and later receiving cumulative transfusions of 10 or more red blood cell units in the initial 24-hour post-injury (massive transfusion) are widely recognized as being at increased risk of morbidity and mortality due to exsanguination. Ideally, these patients should be rapidly identified, however anticipating transfusion needs is challenging. Useful indicators of massive transfusion reviewed in this guideline include: Systolic blood pressure <110 mmHg, heart rate > 105 bpm, hematocrit <32%, pH < 7.25, injury pattern (above-the-knee traumatic amputation especially if pelvic injury is present, multi-amputation, clinically obvious penetrating injury to chest or abdomen), >2 regions positive on Focused Assessment with Sonography for Trauma (FAST) scan, lactate concentration on admission >2.5, admission international normalized ratio .1.2.1.4, near infrared spectroscopy-derived StO2 < 75% (in practice, rarely available), BD > 6 meq/L. Unique aspects of out-ofhospital DCR (point of injury, en-route, and remote DCR) and in-hospital (Medical Treatment Facilities: Role 2b/Forward surgical teams . role 3/combat support hospitals) are reviewed in this guideline, along with pediatric considerations.

Original languageEnglish (US)
Pages (from-to)36-43
Number of pages8
JournalMilitary Medicine
Volume183
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Resuscitation
Wounds and Injuries
Guidelines
Hemorrhage
Exsanguination
Blood Pressure
Tranexamic Acid
International Normalized Ratio
Near-Infrared Spectroscopy
Hemorrhagic Shock
Acidosis
Hypothermia
Hematocrit
Blood Transfusion
Hospital Emergency Service
Lactic Acid
Ultrasonography
Homeostasis
Erythrocytes
Pediatrics

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Cap, A. P., Pidcoke, H. F., Spinella, P., Strandenes, G., Borgman, M. A., Schreiber, M., ... Stockinger, Z. (2018). Damage control resuscitation. Military Medicine, 183, 36-43. https://doi.org/10.1093/milmed/usy112

Damage control resuscitation. / Cap, Andrew P.; Pidcoke, Heather F.; Spinella, Philip; Strandenes, Geir; Borgman, Matthew A.; Schreiber, Martin; Holcomb, John; Tien, Homer Chin Nan; Beckett, Andrew N.; Doughty, Heidi; Woolley, Tom; Rappold, Joseph; Ward, Kevin; Reade, Michael; Prat, Nicolas; Army, French; Ausset, Sylvain; Kheirabadi, Bijan; Benov, Avi; Griffin, Maj Edward P.; Corley, Jason B.; Simon, Clayton D.; Fahie, Roland; Jenkins, Donald; Eastridge, Brian J.; Stockinger, Zsolt.

In: Military Medicine, Vol. 183, 01.01.2018, p. 36-43.

Research output: Contribution to journalArticle

Cap, AP, Pidcoke, HF, Spinella, P, Strandenes, G, Borgman, MA, Schreiber, M, Holcomb, J, Tien, HCN, Beckett, AN, Doughty, H, Woolley, T, Rappold, J, Ward, K, Reade, M, Prat, N, Army, F, Ausset, S, Kheirabadi, B, Benov, A, Griffin, MEP, Corley, JB, Simon, CD, Fahie, R, Jenkins, D, Eastridge, BJ & Stockinger, Z 2018, 'Damage control resuscitation', Military Medicine, vol. 183, pp. 36-43. https://doi.org/10.1093/milmed/usy112
Cap AP, Pidcoke HF, Spinella P, Strandenes G, Borgman MA, Schreiber M et al. Damage control resuscitation. Military Medicine. 2018 Jan 1;183:36-43. https://doi.org/10.1093/milmed/usy112
Cap, Andrew P. ; Pidcoke, Heather F. ; Spinella, Philip ; Strandenes, Geir ; Borgman, Matthew A. ; Schreiber, Martin ; Holcomb, John ; Tien, Homer Chin Nan ; Beckett, Andrew N. ; Doughty, Heidi ; Woolley, Tom ; Rappold, Joseph ; Ward, Kevin ; Reade, Michael ; Prat, Nicolas ; Army, French ; Ausset, Sylvain ; Kheirabadi, Bijan ; Benov, Avi ; Griffin, Maj Edward P. ; Corley, Jason B. ; Simon, Clayton D. ; Fahie, Roland ; Jenkins, Donald ; Eastridge, Brian J. ; Stockinger, Zsolt. / Damage control resuscitation. In: Military Medicine. 2018 ; Vol. 183. pp. 36-43.
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AU - Holcomb, John

AU - Tien, Homer Chin Nan

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