Damage Control Resuscitation: A New Paradigm for Fluid Resuscitation of Severely Injured Soldiers
Abstract
Recent studies have demonstrated that bleeding disorders are common in the most severely injured trauma patients on admission to the hospital, highlighting the importance of treating this coagulopathy at the earliest stage possible. The concept of damage control resuscitation, which includes hypotensive and hemostatic resuscitation components, was introduced as a new approach to treat these patients at the highest risk of dying. Research studies are being conducted in both experimental animals and with human blood to evaluate different aspects of damage control resuscitation (DCR). Swine models of severe hemorrhage that mimics an uncontrolled hemorrhage have been performed in both anesthetized and sedated pigs (n=8-10/gp) to evaluate short term (3 hr) and long term (72 hr) responses to hypotensive fluid resuscitation with lactated Ringer's, Hextend or fresh whole blood to a systolic blood pressure of 80 mmHg. Human blood was evaluated in vitro to determine the activity of recombinant activated factor VII (rFVIIa), a major adjunct in the DCR guidelines under conditions of hemodilution and hypothermia. The results of the swine studies indicated that whole blood may be best, but where its use is limited by logistic constraints, Hextend should be useful for maintaining a casualty up to a few hours. In addition, in vitro data with rFVIIa suggest that it may be a beneficial adjunct promoting hemostasis in cold, coagulopathic trauma patients, such as those seen at the combat support hospital (CSH), without the need to correct the patient 's body temperature prior to the treatment. In addition rFVIIa should also be effective at levels of hemodilution expected in surviving casualties.
Document Details
- Document Type
- Technical Report
- Publication Date
- Nov 01, 2006
- Accession Number
- ADA481805
Entities
People
- Angel V. Delgado
- Bijan Shams Kheirabadi
- Jill L. Sondeen
- John B Holcomb
- Michael A. Dubick
Organizations
- United States Army Institute of Surgical Research