Damage Control Resuscitation (DCR) is a crucial approach in managing critically injured trauma patients, particularly those with severe bleeding and airway management considerations. DCR involves a combination of damage control surgery, permissive hypotension, and hemostatic resuscitation. The primary goal of DCR is to control critical bleeding and trauma-induced coagulopathy, which is essential in preventing further complications and improving patient outcomes (Gando & Hayakawa, 2015; LaGrone, 2023; Wu et al., 2015).
DCR principles have gained widespread acceptance in civilian practice over the past decade due to their effectiveness in preventing and correcting trauma-induced coagulopathy, as well as rapidly controlling hemorrhage. By combining early definitive hemorrhage control, hypotensive resuscitation, and balanced use of blood products, DCR aims to limit blood loss, prevent coagulopathy, and improve patient survival rates (Avery et al., 2020; Jansen et al., 2009).
The use of whole blood (WB) in hemostatic resuscitation has been associated with improved mortality outcomes in major bleeding cases, both in hospital and of significant not, out of hospital by paramedics. Studies support the utilization of WB in trauma patient resuscitation, further emphasizing the importance of appropriate blood product management in DCR (Hazelton et al., 2022).
In both adult and pediatric trauma patients, the principles of DCR remain consistent, focusing on rapid bleeding control, avoidance of hemodilution and related complications, early balanced transfusions with blood products, and the use of hemostatic adjuncts when necessary. These strategies aim to address the "lethal triad" of acute coagulopathy, hypothermia, and acidosis commonly seen in trauma patients (Russell et al., 2023; Kaafarani & Velmahos, 2014).
Overall, DCR plays a vital role in trauma resuscitation, both prehospital and in hospital, by addressing the immediate needs of critically injured patients, such as controlling bleeding, preventing coagulopathy, and maintaining hemostasis. By following DCR principles, healthcare providers can significantly improve patient outcomes and increase the chances of survival in trauma cases (Ramakrishnan & Cattamanchi, 2014; Jacob & Kumar, 2014; Leibner et al., 2020).
References:
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