scholarly journals Damage control surgery: a constant evolution

2020 ◽  
Author(s):  
Rao Ivatury ◽  
David V Feliciano ◽  
Juan Pablo Herrera
Keyword(s):  
World War Ii ◽  
Vietnam War ◽  
Damage Control ◽  
Ischemia Reperfusion ◽  
Damage Control Surgery ◽  
Oliver Goldsmith ◽  
Lethal Triad ◽  
Surgical Bleeding ◽  
Difficult Challenge ◽  
Hepatic Injuries

The story of trauma resuscitation is similar to that of many other advances in medicine: described, forgotten, reinvented, ridiculed, and finally accepted. Even after acceptance, the concepts go through periods of neglect and indifference before they are tried and enhanced, till the next advance. Damage control, a strategy for management of critically injured or ill patients, is a prime example of this phenomenon. It reminds us of the famous words of Oliver Goldsmith in 1761: “for he who fights and runs away, will live to fight another day, but he who is in battle slain, will never rise and fight again”. Damage control was based on the recognition of the lethal triad of hypothermia, acidosis, and a coagulopathy resulting from massive blood loss, large-volume resuscitation and ischemia-reperfusion. It was an approach that J. Hogarth Pringle from Glasgow, Scotland, suggested in 1908 with his principles of compression and hepatic packing for control of venous hemorrhage from the injured liver: temporary, expeditious and effective. Packing, however, was rarely utilized during World War II and the Vietnam War because of the presumed risk of rebleeding with removal of the packs. The ever-difficult challenge of “non-surgical bleeding” from a coagulopathy due to massive hepatic injuries did, eventually, lead to a resurrection of the concept of perihepatic packing in the 1980s in civilian centers and became one of the initial steps in damage control for patients with severe and/or multiple intra-abdominal injuries.

scholarly journals Management of Destructive Colon Injuries after Damage Control Surgery

2017 ◽  
Vol 31 (01) ◽  
pp. 036-040 ◽  
Author(s):  
Priya Prakash ◽  
William Symons ◽  
Jad Chamieh
Keyword(s):  
World War Ii ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Standard Of Care ◽  
Fecal Diversion ◽  
Trauma Patients ◽  
Stoma Formation ◽  
Diverting Stoma ◽  
Life Threatening ◽  
Colon Injuries

AbstractAfter the World War II, fecal diversion became the standard of care for colon injuries, although medical, logistic, and technical advancements have challenged this approach. Damage control surgery serves to temporize immediately life-threatening conditions, and definitive management of destructive colon injuries is delayed until after appropriate resuscitation. The bowel can be left in discontinuity for up to 3 days before edema ensues, but the optimal repair window remains within 12 to 48 hours. Delayed anastomosis performed at the take-back operation or stoma formation has been reported with variable results. Studies have revealed good outcomes in those undergoing anastomosis after damage control surgery; however, they point to a subgroup of trauma patients considered to be “high risk” that may benefit from fecal diversion. Risk factors influencing morbidity and mortality rates include hypotension, massive transfusion, the degree of intra-abdominal contamination, associated organ injuries, shock, left-sided colon injury, and multiple comorbid conditions. Patients who are not suitable for anastomosis by 36 hours after damage control may be best managed with a diverting stoma. Failures are more likely related to ongoing instability, and the management strategy of colorectal injury should be based mainly on the patient's overall condition.

scholarly journals Novel use of XSTAT 30 for mitigation of lethal non-compressible torso hemorrhage in swine

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241906
Author(s):  
Alicia M. Bonanno ◽  
Todd L. Graham ◽  
Lauren N. Wilson ◽  
James D. Ross
Keyword(s):  
Blood Product ◽  
Ischemia Reperfusion Injury ◽  
Damage Control ◽  
Ischemia Reperfusion ◽  
Survival Rates ◽  
Damage Control Surgery ◽  
Left Lobe ◽  
Adverse Outcomes ◽  
Significant Difference ◽  
Similar Survival

Background Management of Non-Compressible Torso Hemorrhage (NCTH) consists primarily of aortic occlusion which has significant adverse outcomes, including ischemia-reperfusion injury, in prolonged field care paradigms. One promising avenue for treatment is through use of RevMedx XSTAT 30™ (an FDA approved sponge-based dressing utilized for extremity wounds). We hypothesized that XSTAT 30™ would effectively mitigate NCTH during a prolonged pre-hospital period with correctable metabolic and physiologic derangements. Methods and findings Twenty-four male swine (53±2kg) were anesthetized, underwent line placement, and splenectomy. Animals then underwent laparoscopic transection of 70% of the left lobe of the liver with hemorrhage for a period of 10min. They were randomized into three groups: No intevention (CON), XSTAT 30™-Free Pellets (FP), and XSTAT 30™-Bagged Pellets (BP). Animals were observed for a pre-hospital period of 180min. At 180min, animals underwent damage control surgery (DCS), balanced blood product resuscitation and removal of pellets followed by an ICU period of 5 hours. Postoperative fluoroscopy was performed to identify remaining pellets or bags. Baseline physiologic and injury characteristics were similar. Survival rates were significantly higher in FP and BP (p<0.01) vs CON. DCS was significantly longer in FP in comparison to BP (p = 0.001). Two animals in the FP group had pellets discovered on fluoroscopy following DCS. There was no significant difference in blood product or pressor requirements between groups. End-ICU lactates trended to baseline in both FP and BP groups. Conclusions While these results are promising, further study will be required to better understand the role for XSTAT in the management of NCTH.

Critical Care Considerations for Damage Control in a Trauma Patient

2021 ◽  
Vol 32 (1) ◽  
pp. 64-75
Author(s):  
Shannon Gaasch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cause Of Death ◽  
Damage Control ◽  
Operative Procedure ◽  
Fixed Ratio ◽  
Damage Control Surgery ◽  
Fluid Restriction ◽  
Damage Control Resuscitation ◽  
Lethal Triad

Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.

scholarly journals Resusitasi Pengendalian Kerusakan Di Unit Perawatan Intensif

2021 ◽  
Vol 36 (2) ◽  
pp. 71-75
Author(s):  
Dhanu Pitra Arianto ◽  
Nurita Dian Kestriani
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Massive Bleeding ◽  
Trauma Patients ◽  
Damage Control Resuscitation ◽  
Early Management ◽  
Severe Haemorrhage ◽  
Lethal Triad ◽  
Clotting Cascade ◽  
Injured Patients

Abstrak Resusitasi dengan pengendalian kerusakanmenggambarkan suatu pendekatan ke perawatan awal pada pasien dengan cedera berat. Tujuan pendekatan ini untuk menjaga pasien tetap stabil dengan menghindari intervensi dan kondisi yang berisiko kepada keadaan perburukan dengan mengendalikan trias kematian, yaitu hipotermia, koagulopati, dan asidosis. Merupakan hal yang penting bahwa konsep dan kepraktisan pendekatan ini dipahami oleh semua yang terlibat dalam manajemen awal pasien trauma. Pendekatan ini dimulai dengan pemberian produk darah sejak awal, penghentian perdarahan dan pengembalian volume darah yang bertujuan untuk mengembalikan stabilitas fisiologis dengan cepat. Resusitasi dengan pengendalian kerusakan memilikibeberapa tambahan pendekatan dari bidang farmakologis dan laboratorium untuk meningkatkan perawatan pasien yang mengalami perdarahan. Pendekatan ini termasuk trombelastografi sebagai ukuran rinci kaskade pembekuan, asam traneksamat sebagai antifibrinolitik.   Kata kunci : hipotermia, koagulopati, asidosis, perdarahan masif     Damage Control Resuscitation in Intensive Care Unit   Abstract Damage control resuscitation (DCR) describes an approach to the early care of very seriously injured patients. The aim is to keep the patient alive whilst avoiding interventions and situations that risk worsening their situation by driving the lethal triad of hypothermia, coagulopathy and acidosis.It is critical that the concepts and practicalities of this approach are understood by all those involved in the early management of trauma patients. Damage control resuscitation forms part of an overall approach to patient care rather than a specific intervention and has evolved from damage control surgery. It is characterised by early blood product administration, haemorrhage arrest and restoration of blood volume aiming to rapidly restore physiologic stability. The infusion of large volumes of crystalloid is no longer appropriate, instead the aim is to replace lost blood and avoid dilution and coagulopathy. In specific situations, permissive hypotension may also be of benefit, particularly in patients with severe haemorrhage from an arterial source. Damage control resuscitation has been augmented by both pharmacologic and laboratory adjuncts to improve the care of the hemorrhaging patient. These include thrombelastography as a detailed measure of the clotting cascade, tranexamic acid as an antifibrinolytic.   Keywords: hypothermia, coagulopathy, acidosis, massive bleeding

scholarly journals Place of preperitoneal pelvic packing in severe pelvic traumatisms: About 20 cases performed in a French military level one trauma center

2021 ◽  
Author(s):  
Hardy Julie ◽  
Coisy Marie ◽  
Monchal Tristan ◽  
Bourguoin Stéphane ◽  
Long Depaquit Thibaut ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Trauma Center ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Safe Procedure ◽  
Pelvic Packing ◽  
Preperitoneal Pelvic Packing ◽  
Arterial Bleeding ◽  
Lethal Triad ◽  
Overall Mortality

AbstractBackgroundThe overall mortality of hemodynamically unstable pelvic fractures is high. Hemorrhage triggers off the Moore lethal triad. Hemostatic management during the golden hour is essential. Combined with pelvic stabilisation, preperitoneal pelvic packing (PPP) is proposed to control venous and bony bleeding, while arterioembolisation can stop arterial bleeding. No international consensus has yet prioritized these procedures. The aim of this study was to analyse a serie of PPP in a military level one trauma center and propose an algorithm for hemodynamically unstable pelvic traumas regardless of the military facility.MethodFrom January 2010 to December 2020, every patient from our military institution with a hemodynamically unstable pelvic fracture underwent PPP combined with pelvic stabilisation. Before 2012 data were retrospectively collected from database (PMSI), after 2012 data were prospectively recorded in our polytrauma database and retrospectively analysed. The care algorithm applied focused on hemodynamic status of polytraumatised patients on admission. Primary criteria were early hemorrhage-induced mortality (<24h) and overall mortality (<30d). Secondary criteria were systolic blood pressure (SBP) and red blood cells (RBC) units administered.Results20 patients with a pelvic fracture had a PPP. Mean age was 49,65 +/-23,97 years and median ISS was 49 (31; 67). The decrease of blood transfusion and increase of SBP between pre- and postoperative values were statistically significant. Eight patients (40%) had postoperative arterial pelvic blush and 7 patients were embolised. The early mortality by refractory hemorrhagic shock was 25% (5/20). Overall mortality at 30 days was 50% (10/20).ConclusionPPP is a quick, easy, efficient and safe procedure. It can control venous, bony and sometimes arterial bleeding. PPP is part of damage control surgery and we propose it in first line. Angio-embolization remains complementary. Besides, PPP is the only means available in precarious conditions of practice, notably in military forward units.

scholarly journals Damage Control Orthopedic Surgery.

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Fatmir Brahimi ◽  
Edvin Selmani ◽  
Leard Duraj
Keyword(s):  
Intensive Care Unit ◽  
Orthopedic Surgery ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Wound ◽  
Successful Resuscitation ◽  
Abdominal Closure ◽  
Lethal Triad ◽  
Rapid Control ◽  
Definitive Repair

The concept of damage control surgery was first described for the purpose of treating medically un-stable patients with abdominal trauma. The purpose of such surgery is rapid control of hemorrhage and contamination, not definitive repair of injuries. The goal is to improve survival of patients with the potentially lethal triad of hypothermia, acidosis and coagulopathy. Definitive repair of injuries and abdominal closure are not performed at the time of initial laparotomy. Rather, the abdominal wound is left open, a dressing is placed, and the patient is transported to the intensive care unit for continued re-suscitation. This includes optimization of hemodynamic condition, respiratory support, warming, and correction of coagulopathy. Following successful resuscitation, when the patient is medically stable, a return to the operating room is scheduled for repair of injuries and abdominal closure.

Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e240202
Author(s):  
Benjamin McDonald
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mesenteric Ischaemia ◽  
Abdominal Symptoms ◽  
Chronic Mesenteric Ischaemia ◽  
Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

Damage control surgery

2021 ◽  
Vol 21 (S1) ◽  
pp. 147-154
Author(s):  
C. Güsgen ◽  
A. Willms ◽  
R. Schwab
Keyword(s):  
Damage Control ◽  
Damage Control Surgery
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