Damage control strategies. Karim Brohi outlines the critical concepts for the managment of the actively bleeding patient.

1. DAMAGE CONTROL RESUSCITATION
Centre for Trauma Sciences
Queen Mary University of London
www.c4ts.qmul.ac.uk
Royal London Major Trauma Centre
Barts Health NHS Trust
KARIM BROHI, FRCS FRCA
Professor of Trauma Sciences, QMUL

4. National Trauma Haemorrhage Mortality Rates

6. 43%

8. 0
10
20
30
40
50
60
70
ISS > 15 ISS > 24Injury Severity Score
Mortality(%)
RLH
MSH
CH
*
*
Comparative Mortality

16. Damage Control Resuscitation

17. Damage Control Resuscitation
MAINTAIN HAEMOSTATIC
COMPETENCE

18. Damage Control Resuscitation
1. Early haemorrhage control (DCS)
2. Permissive hypotension
3. Limit fluid infusions (dilution)
4. Target coagulopathy

19. Damage Control Resuscitation
1. Early haemorrhage control (DCS)
2. Permissive hypotension
3. Limit fluid infusions (dilution)
4. Target coagulopathy

21. Trauma patients are more likely to
die from intra-operative metabolic
failure than from a failure to
complete operative repairs.

22. Trauma patients are more likely to
die from intra-operative metabolic
failure than from a failure to
complete operative repairs.
Haemorrhage Control

23. Trauma patients are more likely to
die from intra-operative metabolic
failure than from a failure to
complete operative repairs.
Haemorrhage Control
Manage Sepsis
Protect from further injury

24. Trauma patients are more likely to
die from intra-operative metabolic
failure than from a failure to
complete operative repairs.
Restoration of Physiology
(ICU)

26. What is it really?

27. FAILURE:

28. FAILURE:
to maintain homeostasis

29. FAILURE:
to protect cells, tissues & organs

30. FAILURE:
to preserve endothelial integrity

32. What’s bad about DCS?

38. Damage Control Resuscitation
1. Early haemorrhage control (DCS)
2. Permissive hypotension
3. Limit fluid infusions (dilution)
4. Target coagulopathy

45. Damage Control Resuscitation
1. Early haemorrhage control (DCS)
2. Permissive hypotension
3. Limit fluid infusions (dilution)
4. Target coagulopathy

48. Trauma
Hemorrhage
Shock
ATC
TRAUMA-INDUCED
COAGULOPATHY (TIC)

49. Trauma
Hemorrhage
Genetics
Shock
Fibrinolysis Inflammation Hypothermia Acidemia
Loss, Dilution
ATC
TRAUMA-INDUCED
COAGULOPATHY (TIC)

59. 750 ml crystalloid
1U PRBC

60. 750 ml crystalloid
4U PRBC
2 FFP

61. 4500 ml crystalloid
500 colloid
8U PRBC
7U FFP
1 PLT, 2 CRYO

62. 7500 ml crystalloid
1000 colloid
12U PRBC
8U FFP
1 PLT, 2 CRYO

63. 0.3 0.4 0.5 0.6 0.7 0.8 0.9
30
40
50
60
70
80
Center Mean FFP:RBC
PercentSurviving
AB
BC
FF
GH
HI
IJ
LM
MM
OP
PP
QQ
ST
VX
WW
WX
XY
p = 0.05
R
2
= 0.19
34 ISS 44
27 ISS 34
22 ISS 27

67. *
*

68. 0
10
20
30
40
50
60
70
ISS > 15 ISS > 24Injury Severity Score
Mortality(%)
RLH
MSH
CH
*
*
Comparative Mortality

69. Damage Control Resuscitation
1. Early haemorrhage control (DCS)
2. Permissive hypotension
3. Limit fluid infusions (dilution)
4. Target coagulopathy