Document Detail


Damage control resuscitation in combination with damage control laparotomy: a survival advantage.
MedLine Citation:
PMID:  20622577     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Damage control laparotomy (DCL) improves outcomes when used in patients with severe hemorrhage. Correction of coagulopathy with close ratio resuscitation while limiting crystalloid forms a new methodology known as damage control resuscitation (DCR). We hypothesize a survival advantage in DCL patients managed with DCR when compared with DCL patients managed with conventional resuscitation efforts (CRE). METHODS: This study is a 4-year retrospective study of all DCL patients who required >or=10 units of packed red blood cells (PRBC) during surgery. A 2-year period after institution of DCR (DCL and DCR) was compared with the preceding 2 years (DCL and CRE). Univariate analysis of continuous data was done with Student's t test followed by multiple logistic regression. RESULTS: One Hundred twenty-four and 72 patients were managed during the DCL and CRE and DCL and DCR time periods, respectively. Baseline patient characteristics of age, Injury Severity Score, % penetrating, blood pressure, hemoglobin, base deficit, and INR were similar between groups. There was no difference in quantity of intraoperative PRBC utilization between DCL and CRE and DCL and DCR study periods: 21.7 units versus 25.5 units (p = 0.53); however, when compared with DCL and CRE group, patients in the DCL and DCR group received less intraoperative crystalloids, 4.7 L versus 14.2 L (p = 0.009); more fresh frozen plasma (FFP), 18.2 versus 6.4 (p = 0.002); a closer FFP to PRBC ratio, 1 to 1.2 versus 1 to 4.2 (p = 0.002); platelets to PRBC ratio, 1:2.3 versus 1:5.9 (0.002); shorter mean trauma intensive care unit length of stay, 11 days versus 20 days (p = 0.01); and greater 30-day survival, 73.6% versus 54.8% (p < 0.009). The addition of DCR to DCL conveyed a survival benefit (odds ratio; 95% confidence interval: 0.19 (0.05-0.33), p = 0.005). CONCLUSION: This is the first civilian study that analyses the impact of DCR in patients managed with DCL. During the DCL and DCR study period more PRBC, FFP, and platelets with less crystalloid solution was used intraoperatively. DCL and DCR were associated with a survival advantage and shorter trauma intensive care unit length of stay in patients with severe hemorrhage when compared with DCL and CRE.
Authors:
Juan C Duchesne; Katerina Kimonis; Alan B Marr; Kelly V Rennie; Georgia Wahl; Joel E Wells; Tareq M Islam; Peter Meade; Lance Stuke; James M Barbeau; John P Hunt; Christopher C Baker; Norman E McSwain
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  69     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-08-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  46-52     Citation Subset:  AIM; IM    
Affiliation:
Section of Trauma and Critical Care Surgery, Department of Surgery, Emergency Medicine and Anesthesia, Tulane University Health Science Center, New Orleans, Louisiana 70112-2699, USA. jduchesn@tulane.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Transfusion
Female
Hemorrhage / mortality,  surgery*
Humans
Injury Severity Score
Laparotomy / methods,  mortality*
Male
Multivariate Analysis
Regression Analysis
Rehydration Solutions / therapeutic use
Resuscitation / methods,  mortality*
Retrospective Studies
Survival Analysis
Wounds and Injuries / mortality,  surgery*
Wounds, Nonpenetrating / mortality,  surgery*
Wounds, Penetrating / mortality,  surgery
Chemical
Reg. No./Substance:
0/Rehydration Solutions

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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