Damage control resuscitation

Abstract

The United States Navy originally utilized the concept of damage control to describe the process of prioritizing the critical repairs needed to return a ship safely to shore during a maritime emergency. To pursue a completed repair would detract from the goal of saving the ship. This concept of damage control management in crisis is well suited to the care of the critically ill trauma patient, and has evolved into the standard of care. Damage control resuscitation is not one technique, but, rather, a group of strategies which address the lethal triad of coagulopathy, acidosis, and hypothermia. In this article, we describe this approach to trauma resuscitation and the supporting evidence base.

Keywords: Advanced Trauma Life Support Care; Blood Component Transfusion; Blood Transfusion; Infusions, Intravenous; Platelet Transfusion; Resuscitation; Wounds and injuries.

Fig. 1.

The deadly triad in trauma.

Fig. 2.

Overview of the pathophysiology of acute traumatic coagulopathy. APC, Activated protein C.

Fig. 3.

Tenets of damage control resuscitation.

Fig. 4.

R=reaction time (s), K=kinetics (s), alpha=angle (slope of line between R and K), MA=maximum amplitude (mm), LY30=amplitude at 30 minutes.