Damage Control
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Damage control concepts are not restricted to the abdomen and extend to every cavity in the body as well as vascular damage control. The need for damage control in children is much less common; however, they are much more prone to hypothermia given larger surface area relative to their smaller blood volume. Although the physiological parameters are very different, the principles are the same. At the other end of the spectrum, the application of damage control to the elderly who have decreased physiological reserve and a high morbidity and mortality has also been successful, with survival of greater than 50% when damage control is applied to this group.2 Damage control surgery may be performed in smaller hospitals before transfer to a larger centre. Damage control surgery procedures, on properly selected patients, can be life-saving, and may have to be performed in any hospital admitting trauma cases.
Pediatric thoracic trauma
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
If emergent operative intervention for thoracic trauma or polytrauma is required, the pediatric patient is likely hemodynamically unstable. Damage control surgery is an approach to the severely injured patient that prioritizes rapid surgical control of bleeding and contamination, appropriate resuscitation to address shock and coagulopathy while minimizing iatrogenic injury (hypothermia, hemodilution), and temporary closure to allow for second-look operations and delayed definitive repair. Damage control as a pediatric general surgery principle has been in practice for decades (e.g., use of silos in congenital abdominal wall defects) [11], and its use in pediatric trauma patients has evolved more recently [12–15] as evidence in adults suggests improved survival and outcomes [16–18].
Truncal vascular trauma
Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long in Endovascular and Open Vascular Reconstruction, 2017
Damage control surgery describes a staged or delayed approach to the definitive repair of injuries to limit or reverse physiologic deterioration and subsequent consequences on patients who are exsanguinating. The most important resuscitative maneuver available for patients with NCTH and severe shock is thoracic aortic occlusion. The effects of aortic clamping performed through a left anterolateral thoracotomy (resuscitative thoracotomy) are basically to slow distal hemorrhage and improve cerebral and myocardial perfusion (Figure 51.1). In addition, lung parenchymal bleeding can be compressed, air leaks from bronchial injuries controlled, and the pericardium opened to release any tamponade. This maneuver can be applied to patients with tense hemoperitoneum to control inflow to the abdomen.
Outcomes and clinical characteristics of transmural intestinal necrosis in acute mesenteric ischemia
Published in Scandinavian Journal of Gastroenterology, 2019
Xinyu Wang, Chengnan Chu, Shilong Sun, Tian Xie, Zehua Duan, Kai Wang, Baochen Liu, Xinxin Fan, Xingjiang Wu, Weiwei Ding
Patients with AMI were administrated by multidisciplinary stepwise management strategy that focused on early mesenteric recanalization and retention of bowel viability as previous reports [6,13]. First, mesenteric recanalization was performed in a hybrid operating room. For patients with superior mesenteric artery (SMA) and endovascular therapy (aspiration embolectomy or thrombectomy, stenting and thrombolysis) were used. When endovascular approach failed, laparotomy and exposure of the SMA were performed, especially for retrograde SMA recanalization, involving local thrombectomy and angioplasty, followed by retrograde stent. Endovascular procedures for mesenteric vein thrombosis include mechanical thrombectomy and local thrombolysis via catheter. Then damage control surgery would be applied for patients with emergency laparotomy. The intestinal ostomy was performed in patients with necrotic bowel resection. Temporary abdominal closure with an abdominal sandwich dressing with negative pressure and irritation system was applied to patients with high risk of intra-abdominal hypertension and second laparotomy. And for patients with intestinal stricture, primary anastomosis was executed. After mesenteric recanalization procedures, all patients were transferred into surgical ICU receiving resuscitation, antibiotic therapy, multiple-organ function support and nutrition therapy.
A Novel Method of Damage Control for Multiple Discontinuous Intestinal Injuries with Hemorrhagic Shock: A Controlled Experiment
Published in Journal of Investigative Surgery, 2020
Weihang Wu, Zhicong Cai, Nan Lin, Weijin Yang, Jie Hong, Li Lin, Zhixiong Lin, Junchuan Song, Yongchao Fang, Chen Lin, Hongwen Zhang, Dongsheng Chen, Yu Wang
The principle of damage control surgery was staged treatment, so as to minimize damage and save more intestines. Thus, the intestinal segments suspected for necrosis were temporarily preserved in the early stage of trauma. However, the suspicious necrotic intestine is equivalent to a time bomb. They may recover in the later stage of treatment, or may be necrosis in a short time. Once an intestinal segment becomes necrotic, it can also involve adjacent intestinal segments. The experimental results of the present study showed that intestinal ligation can accelerate the necrotization process in intestines suspicious for necrosis. As an alternative method, we used BST to restore the continuity of intestinal segments with the potential for necrosis, which provided favorable conditions and time for intestinal function recovery and for maximum retention of the surviving intestinal segments.
Current strategies for hemostatic control in acute trauma hemorrhage and trauma-induced coagulopathy
Published in Expert Review of Hematology, 2018
Michael Caspers, Marc Maegele, Matthias Fröhlich
The current trauma guidelines have now recognized ATC as an own clinical entity with substantial impact on outcome and, therefore, recommend the implementation and rapid activation of local transfusion protocols and algorithms integrated in a multimodal approach for hemostatic control [19–21]. The concept of damage control resuscitation (DCR) has been introduced as a natural evolution of the well-established concept of damage control surgery/orthopedics (DCS/O) with focus on early and aggressive bleeding control combined with “permissive hypotension,” avoiding dilutional coagulopathy and crystalloids, and treating established coagulopathy through the early use of blood products and hemostatic agents [22–24]. Based upon large experience from both military and civilian settings, DCR builds up on the administration of blood products in predefined and fixed ratios and has frequently been linked to improved outcomes compared to pRBC and crystalloid-based resuscitation [25,26]. Different guidelines on both sides of the Atlantic, e.g. NHS, EAST, and the European trauma guideline (ETG), have defined specific ratios of packed red blood cells (pPBCs), plasma (fresh-frozen plasma, FFP or pathogen-inactivated plasma) and platelets for early hemostatic control, but the optimum ratio of blood products to be transfused in the acute setting of trauma hemorrhage is still subject of both clinical and scientific controversy. In addition, there is no universal recommendation backed by large evidence yet to the use of factor concentrates (e.g. Prothrombin complex concentrates, PCC) or single coagulation factors (Fibrinogen (FI), FVII) within these algorithms.
Related Knowledge Centers
- Anatomy
- Bleeding
- Coagulation
- Hypothermia
- Metabolic Acidosis
- Homeostasis
- Trauma Triad of Death
- Trauma Surgery