Remote Damage Control Resuscitation in Austere Environments

Ronald Chang, Brian J. Eastridge, John B. Holcomb

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations

Abstract

Hemorrhage is the leading cause of preventable military and civilian trauma death. Damage control resuscitation with concomitant mechanical hemorrhage control has become the preferred in-hospital treatment of hemorrhagic shock. In particular, plasma-based resuscitation with decreased volumes of crystalloids and artificial colloids as part of damage control resuscitation has improved outcomes in the military and civilian sectors. However, translation of these principles and techniques to the prehospital, remote, and austere environments, known as remote damage control resuscitation, is challenging given the resource limitations in these settings. Rapid administration of tranexamic acid and reconstituted freeze-dried (lyophilized) plasma as early as the point of injury are feasible and likely beneficial, but comparative studies in the literature are lacking. Whole blood is likely the best fluid therapy for traumatic hemorrhagic shock, but logistical hurdles need to be addressed. Rapid control of external hemorrhage with hemostatic dressings and extremity tourniquets are proven therapies, but control of noncompressible hemorrhage (ie, torso hemorrhage) remains a significant challenge.

Original languageEnglish (US)
Pages (from-to)S124-S134
JournalWilderness and Environmental Medicine
Volume28
Issue number2
DOIs
StatePublished - Jun 2017

Keywords

  • hemorrhage
  • hemorrhagic shock
  • remote damage control resuscitation

ASJC Scopus subject areas

  • Emergency Medicine
  • Public Health, Environmental and Occupational Health

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