Damage Control Surgery and Damage Control Resuscitation
Damage Control Surgery and Damage Control Resuscitation
Appropriate patient selection for DCS is critical. Attempts at primary definitive surgical management in patients with severe physiological compromise will almost inevitably lead to poor outcome or unplanned abbreviation of the procedure. In contrast, excessively liberal use of DCS may deny patients with adequate physiological reserve the benefits of effective early management and condemn them to unnecessary extra procedures with attendant morbidity and potential for mortality. There are published data to guide patient selection but no single 'physiological threshold' has been defined. Over liberal application of DCS has significant resource implications for theatres and ICU and may increase the risk of intra-abdominal infection, fistula formation and abdominal wall hernias.
If not identified before operation by mechanism or injury pattern, indications to change to a damage control strategy are primarily those of physiological derangement; significant bleeding requiring massive transfusion (>10 units PRBC); severe metabolic acidosis (pH<7.30); hypothermia (temperature <35°C); operative time >90 min; coagulopathy either on laboratory results or seen as 'non-surgical' bleeding; or lactate >5 mmol litre.
Overall, it is estimated that ~10% of major trauma patients might benefit from DCS but there is no single factor that predicts who these patients are. However, the later that the decision to damage control is made, the less successful the outcome is likely to be.
Indications for Damage Control
Appropriate patient selection for DCS is critical. Attempts at primary definitive surgical management in patients with severe physiological compromise will almost inevitably lead to poor outcome or unplanned abbreviation of the procedure. In contrast, excessively liberal use of DCS may deny patients with adequate physiological reserve the benefits of effective early management and condemn them to unnecessary extra procedures with attendant morbidity and potential for mortality. There are published data to guide patient selection but no single 'physiological threshold' has been defined. Over liberal application of DCS has significant resource implications for theatres and ICU and may increase the risk of intra-abdominal infection, fistula formation and abdominal wall hernias.
If not identified before operation by mechanism or injury pattern, indications to change to a damage control strategy are primarily those of physiological derangement; significant bleeding requiring massive transfusion (>10 units PRBC); severe metabolic acidosis (pH<7.30); hypothermia (temperature <35°C); operative time >90 min; coagulopathy either on laboratory results or seen as 'non-surgical' bleeding; or lactate >5 mmol litre.
Overall, it is estimated that ~10% of major trauma patients might benefit from DCS but there is no single factor that predicts who these patients are. However, the later that the decision to damage control is made, the less successful the outcome is likely to be.
