Damage Control Resuscitation: More Than Just Transfusion Strategies

Trauma hemorrhage continues to carry a high mortality worldwide. The contemporary damage control resuscitation (DCR) paradigm supports actively bleeding trauma patients until hemorrhage control is achieved. The principles of DCR center on early hemorrhage control and limiting ongoing blood loss by adopting strategies limiting fluid administration, reducing blood pressure targets, and maintaining hemostasis through balanced transfusion strategies. Application of DCR strategies has dramatically reduced mortality from trauma hemorrhage and also seems to reduce the incidence and severity of complications such as organ failure and infection. While much of the discussion around DCR focuses on control of coagulopathy and the delivery of a balanced transfusion, the other principles are at least as important. Avoiding clear fluids solutions, especially at the most critical timepoints, require experience and a coordinated, practiced, multidisciplinary approach. The anesthesiologist therefore has a central role to play in the successful delivery of DCR, and perioperative management of fluid administration and the patient’s cardiovascular status can make all the difference between a good and bad outcome. In this article, we discuss the principles of DCR with a focus on areas of trauma anesthesiology management.