Author: Duchesne, Juan Carlos; Pereira, Bruno Monteiro; Fraga, Gustavo Pereira
Title: Damage Control Resuscitation Cord-id: h42qwx46 Document date: 2013_8_19
ID: h42qwx46
Snippet: Damage control resuscitation is a resuscitation modality that integrates permissive hypotension, hemostatic resuscitation, and damage control surgery, initially addressing all three components of the “lethal triadâ€: coagulopathy, acidosis, and hypothermia. Trauma patients predicted to require massive transfusion, administration of fresh frozen plasma, packed red blood cells, and platelets in a 1:1:1 ratio (of individual units) are associated with improved survival and less need for innumerou
Document: Damage control resuscitation is a resuscitation modality that integrates permissive hypotension, hemostatic resuscitation, and damage control surgery, initially addressing all three components of the “lethal triadâ€: coagulopathy, acidosis, and hypothermia. Trauma patients predicted to require massive transfusion, administration of fresh frozen plasma, packed red blood cells, and platelets in a 1:1:1 ratio (of individual units) are associated with improved survival and less need for innumerous transfusions. In addition, the evidence so far indicates that the incorporation of these principles into a MTP will also contribute to less transfused units by minimizing variability of transfusion practices. Importantly, fewer units transfused will contribute to fewer complications associated with transfusions. These conclusions will need to be verified, especially with regard to the effect of MTPs incorporating higher ratios of FFP:PRBC:platelets effect on varying mechanism of injury, the timing of transfusions, and the number of units actually transfused. Also recombinant factor VIIa, cryoprecipitate, and tranexamic acid can be considered adjunctive treatments for coagulopathy. Lastly, damage control surgery is a surgical strategy aimed at restoring normal physiology rather than anatomical integrity; however, this component of damage control resuscitation should not be applied in isolation.
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