The Effectiveness of a Damage Control Resuscitation Strategy for Vascular Injury in a Combat Support Hospital: Results of a Case Control Study

Advancements in combat casualty care have resulted in a significant reduction in mortality when compared with previous wars as current research has focused much attention on preventable death. Hemorrhage from extremity vascular injury remains a leading cause of potentially preventable death on the modern battlefield and recent estimates suggest an increase in this injury pattern compared with previous wars. Injuries of this severity cause an early and profound coagulopathy that is often present at admission to the emergency department (ED). Standard damage control principles are routinely applied to achieve rapid hemorrhage control, and to initiate a hemostatic resuscitation plan that will correct metabolic imbalances and prevent the onset or progression of a traumatic coagulopathy. Only when this lifesaving sequence is properly executed, can the military trauma patient be expected to withstand the metabolic perturbations of a complicated operation like extremity revascularization. Standard surgical doctrine and experience has taught surgeons that the operative patient needs to be adequately resuscitated before embarking on a taxing operative course. The time needed for adequate resuscitation was the single greatest barrier to limb salvage during the Korean conflict. Convincing modern data show that acidosis and traditional resuscitation techniques using liberal amounts of crystalloid and packed red blood cells (PRBCs) can exacerbate coagulopathy. One report has recently demonstrated a survival benefit with early correction of these physiologic derangements. Given modern advances, it seems logical to optimize those strategies that promote early recovery from the metabolic consequences of hemorrhagic shock.
Published in the Jnl. of Trauma Injury, Infection, and Critical Care, Feb Supplement 2008, v64, n2, p599-S107.