Damage Control Resuscitation Reduces Resuscitation Volumes And Improves Survival In 390 Damage Control Laparotomy Patients
Bryan A Cotton, MD*, Neeti Reddy, MD*, Quinton M Hatch, MD*, Eric LeFebvre, MD*, Charles E Wade, MD*, Rosemary A Kozar, MD, Brijesh S Gill, MD*, Rondel Albarado, MD*, Michelle K McNutt, MD*, John B Holcomb, MD
University of Texas Health Science Center-Houston, Houston, TX
OBJECTIVE: Damage control laparotomy (DCL) focuses on control of hemorrhage and gross bowel spillage. Damage control resuscitation (DCR) aims at preventing coagulopathy through limiting crystalloids and delivering higher ratios of plasma and platelets. The purpose of the study was to determine if implementation of DCR in DCL patients would translate to improved survival.
METHODS: A retrospective review of all emergent trauma laparotomies between 01/2004-08/2010 was performed. Patients were divided into pre-DCR and DCR groups, and were excluded if they died prior to completion of the initial laparotomy. The lethal triad was defined as temperature 1.5, or pH<7.30.
RESULTS: 1217 patients were included, 390 (32%) underwent DCL. Of these, 282 were pre-DCR and 108 were DCR. Groups were similar in demographics, injury severity, arrival vitals and laboratory values. DCR patients received less crystalloids (median 14L vs. 5L), RBC (13U vs. 7U), plasma (11U vs. 8U) and platelets (6U vs. 0U) by 24-hr; all p<0.05. DCR had less evidence of the lethal triad upon ICU arrival (88% vs. 46%, p<0.001). 24-hour and 30-day survival was higher in DCR (88% vs. 97%, p=0.006 and 76% vs. 86%, p=0.03). After controlling for age, injury severity and ED variables, multivariate analysis demonstrated DCR was associated with a significant increase in 30-day survival (Odds ratio 2.5, 95% C.I. 1.10-5.58, p=0.03).
CONCLUSIONS: In severely injured patients undergoing DCL, this new resuscitation paradigm resulted in reduced crystalloid and blood product administration and was associated with an improvement in 30-day survival.
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