Damage control resuscitation: the need for specific blood products to treat the coagulopathy of trauma

Abstract : Civilian trauma centers and military combat support hospitals have evolved to treat increasingly severe injury. Today, they routinely save patients whose care would have been futile two decades ago. The most important advance has been an approach called damage control surgery in which the restoration of normal anatomy is deferred to limit the progression of coagulopathy. This technique has been developed to the point that it has outstripped conventional blood bank support. Uncontrolled coagulopathic hemorrhage is now the major cause of potentially preventable death following trauma. Roughly 1 in 10 people in the United States is brought to or seeks medical care for injury each year. One in a 100 is hospitalized, and approximately 1 in a 1000 receives blood products as part of the acute treatment of injury. At the University of Maryland Shock-Trauma Center (UMSTC) in calendar year 2000, 8 percent of 5649 injured patients admitted directly from the scene of injury received RBCs during their hospital stay, 5 percent received plasma, 3 percent received PLTs, and 0.1 percent received cyroprecipitate.