Damage Control Resuscitation DCR

Damage Control Resuscitation DCR

Damage control resuscitation consist of 3 main component :

I.  Hemostatic resuscitation

II. Permeasive hypotension

III. Damage control surgery

I. Hemostatic Resuscitation

- early use of whole blood or combined replaced blood component.

Aim : prevent dilutional coagulopathy & treat intrinsic coagulopathy.

Recent study:

1. PRBC:FFP:Plt = 1:1:1

Result:

Increases number of survival of massive haemorrhage.

2. If plasma fibrinogen level <1.5g/L: give fibrinogen concentrate as part of massive transfusion protocol.

3. Recombinant factor VII

- if all other measure fail

- dosage: 100mcg/kg

4. Tranxaemic acid

- recommended as adjunct to reduce bleeding in trauma patient

According to Crash-2 Trial

• dosage: IV 1g over 10min then 1g over 8H
• reduced the mortality if given within 3H
• reduced bleeding & mortality if given within 1H. 

Role of Thromboelastography and theomboelastometry in acute coagulopathy :

• Assessment of coagulation deficiency
• Used as point of care testing 
• Currently recommended in massive transfusion protocol & hemostatic resuscitation. 

(II) Permeasive hypotension

" hypotension resuscitation"

- restriction fluid resuscitation until bleeding control.

- goal: SBP 90mmhg for adequate end organ perfussion.

- only useful in 1st hour following traumatic injury.

- evidence only in penetrating injuries

Contraindicated in

•  TBI 
• Child <12 year
• Blast injury 

Goal directed therapy:

1. SBP 90mmhg

2. HR <100

3. Urine output >0.5mls/kg/hour

Recommendation :

Bolus of 250mls & monitor response of CVP , MAP , pH of central venous , SVCO2 >70%

Which fluid?

0.9% NS according to  NICE studies.

Concern :

Bleeding not control

Fluid resuscitation to normal BP might be harmful as exacerbating ongoing haemorrhage by dislodge the clots.

Adverse effect :

Regional hypoperfussion , eg splanchic hypoperfussion

(III) damage control surgery

• Stop haemorrhage 
• Avoid contamination 
• Optimize physiological function 

Rapid initiation surgery and hemostasis , definitive surgery done later.