Wednesday, March 12, 2014

What is Damage Control Resuscitation?

The concept of damage control resuscitation (DCR) was proposed in the mid 2000s as an alternative resuscitation approach to hemorrhagic shock. A key component of this damage control approach is early hemorrhage control. Another core concept is that resuscitation fluids should resemble what the trauma patient loses—warm fresh whole blood. In civilian settings, fresh whole blood is not available for transfusion, and blood components in appropriate ratios should be used toward this goal. A number of studies suggest that FFP and platelets should be given early and in high ratios (e.g., PRBCs/FFP/ platelets in a ratio of 1:1:1) in patients who require massive transfusion (>10 units PRBCs).

Damage control resuscitation involves:

·         Rapid control of surgical bleeding

·         Early and increased use of red blood cells, plasma and platelets in a 1:1:1 ratio

·         Limitation of excessive crystalloid use

·         Prevention and treatment of hypothermia, hypocalcemia and acidosis

·         Hypotensive resuscitation strategies

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