Resuscitation in Trauma, Damage Control Resuscitation, and Trauma Induced Coagulopathy

The fellow should be able to:

• Demonstrate an understanding of balanced resuscitation in trauma, including the history of development of this concept, indications, and controversies
• Understand the role of crystalloid in resuscitation and the complications associated with the overuse of crystalloid
• Describe the role of colloid in trauma resuscitation
• Understand the rationale behind hypotensive resuscitation and recognize the patients most likely to benefit
• Understand the pathophysiology that leads to coagulopathy in trauma patients
• Describe the role of viscoelastic testing and traditional coagulation tests in trauma patients
• Recognize the controversies of viscoelastic testing-guided resuscitation and ratio-based resuscitation
• Describe the role of TXA in trauma resuscitation including current controversies
• Describe the role of calcium in trauma resuscitation
• Describe the use and indications for direct peritoneal resuscitation

Resources

• Topic Summary
• Meet the Mentors - Damage Control Resuscitation
• Meet the Mentors - Blood Products: Therapy for Endothelium
• Meet the Mentors - Blood Products: Current Use and Future Options
• Meet the Mentors - Trauma-Induced Coagulopathy
• Overview Article 
  • LTC(P) Andrew P. Cap, MD, PhD; Heather F. Pidcoke, MD, PhD; et al. Damage Control Resuscitation. Mil Med 2018.
• Additional Resources
  • T.P. Whitton and W.J. Healy. Review of Thromboelastography (TEG): Medical and Surgical Applications. Ther Adv Pulm Crit Care Med 2023.
  • Griffin J. Feinberg, ScM; Anastasia C. Tillman, MD; et al. Maintaining a Whole Blood-Centered Transfusion Improves Survival in Hemorrhagic Resuscitation. J Trauma Acute Care Surg 2023.
  • Jan O. Jansen, PhD; Jemma Hudson, PhD; et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA 2023.
  • Joseph J. DuBose, MD; Thomas M. Scalea, MD; et al. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg 2016.
• EAST Guidelines
  • Damage Control Resuscitation in Patients with Severe Traumatic Hemorrhage