Download PDF
Clin Colon Rectal Surg 2018; 31(01): 030-035
DOI: 10.1055/s-0037-1602177
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Evolution of Damage Control in Concept and Practice

Brian C. Beldowicz
1   Division of Military, Department of Emergency Medicine, Uniformed Services University of the Health Sciences, Sacramento, California
› Author Affiliations
Further Information

Publication History

Publication Date:
19 December 2017 (online)

    Permissions and Reprints

Abstract

Damage control surgery (DCS) began as an adjunct approach to hemorrhage control, seeking to facilitate the body's innate clotting ability when direct repair or ligation was impossible, but it has since become a valuable instrument for a broader collection of critically ill surgical patients in whom metabolic dysfunction is the more immediate threat to life than imminent exsanguination. Modern damage control is a strategy that combines the principles of DCS with those of damage control resuscitation. When used correctly, damage control may improve survival in previously unsalvageable patients; when used incorrectly, it can subject patients to imprudent risk and contribute to morbidity. This review discusses the evolution of damage control in both concept and practice, summarizing available literature and experience to guide patient selection, medical decision-making, and strategy implementation throughout the preoperative, intraoperative, and early postoperative periods.

Keywords

damage control - damage control surgery - damage control resuscitation - lethal triad
 

  • References

  • 1 Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev 2013; 3 (03) CD007438
    PubMedGoogle Scholar
  • 2 Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 1908; 48 (04) 541-549
    CrossrefPubMedGoogle Scholar
  • 3 Aprahamian C, Wittmann DH, Bergstein JM, Quebbeman EJ. Temporary abdominal closure (TAC) for planned relaparotomy (etappenlavage) in trauma. J Trauma 1990; 30 (06) 719-723
    CrossrefPubMedGoogle Scholar
  • 4 Feliciano DV, Mattox KL, Burch JM, Bitondo CG, Jordan Jr GL. Packing for control of hepatic hemorrhage. J Trauma 1986; 26 (08) 738-743
    CrossrefPubMedGoogle Scholar
  • 5 Cué JI, Cryer HG, Miller FB, Richardson JD, Polk Jr HC. Packing and planned reexploration for hepatic and retroperitoneal hemorrhage: critical refinements of a useful technique. J Trauma 1990; 30 (08) 1007-1011 , discussion 1011–1013
    CrossrefPubMedGoogle Scholar
  • 6 Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg 1983; 197 (05) 532-535
    CrossrefPubMedGoogle Scholar
  • 7 Kashuk JL, Moore EE, Millikan JS, Moore JB. Major abdominal vascular trauma--a unified approach. J Trauma 1982; 22 (08) 672-679
    CrossrefPubMedGoogle Scholar
  • 8 Burch JM, Ortiz VB, Richardson RJ, Martin RR, Mattox KL, Jordan Jr GL. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg 1992; 215 (05) 476-483 , discussion 483–484
    CrossrefPubMedGoogle Scholar
  • 9 Rotondo MF, Schwab CW, McGonigal MD. , et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35 (03) 375-382 , discussion 382–383
    CrossrefPubMedGoogle Scholar
  • 10 Rotondo MF, Zonies DH. The damage control sequence and underlying logic. Surg Clin North Am 1997; 77 (04) 761-777
    CrossrefPubMedGoogle Scholar
  • 11 Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF. Damage control: collective review. J Trauma 2000; 49 (05) 969-978
    CrossrefPubMedGoogle Scholar
  • 12 Sümpelmann R, Schürholz T, Thorns E, Hausdörfer J. Acid-base, electrolyte and metabolite concentrations in packed red blood cells for major transfusion in infants. Paediatr Anaesth 2001; 11 (02) 169-173
    CrossrefPubMedGoogle Scholar
  • 13 Reddi BA. Why is saline so acidic (and does it really matter?). Int J Med Sci 2013; 10 (06) 747-750
    CrossrefPubMedGoogle Scholar
  • 14 Morgan TJ. The meaning of acid-base abnormalities in the intensive care unit: part III -- effects of fluid administration. Crit Care 2005; 9 (02) 204-211
    CrossrefPubMedGoogle Scholar
  • 15 Cotton BA, Reddy N, Hatch QM. , et al. Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients. Ann Surg 2011; 254 (04) 598-605
    CrossrefPubMedGoogle Scholar
  • 16 Veech RL. Immediate versus delayed fluid resuscitation in patients with trauma. N Engl J Med 1995; 332 (10) 681-682 , author reply 682–683
    CrossrefPubMedGoogle Scholar
  • 17 Roberts I, Evans P, Bunn F, Kwan I, Crowhurst E. Is the normalisation of blood pressure in bleeding trauma patients harmful?. Lancet 2001; 357 (9253): 385-387
    CrossrefPubMedGoogle Scholar
  • 18 Winchell RJ, Simons RK, Hoyt DB. Transient systolic hypotension. A serious problem in the management of head injury. Arch Surg 1996; 131 (05) 533-539 , discussion 539
    CrossrefPubMedGoogle Scholar
  • 19 Duchesne JC, Heaney J, Guidry C. , et al. Diluting the benefits of hemostatic resuscitation: a multi-institutional analysis. J Trauma Acute Care Surg 2013; 75 (01) 76-82
    CrossrefPubMedGoogle Scholar
  • 20 Ley EJ, Clond MA, Srour MK. , et al. Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients. J Trauma 2011; 70 (02) 398-400
    CrossrefPubMedGoogle Scholar
  • 21 Neal MD, Hoffman MK, Cuschieri J. , et al. Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way. J Trauma Acute Care Surg 2012; 72 (04) 892-898
    CrossrefPubMedGoogle Scholar
  • 22 Hewson JR, Neame PB, Kumar N. , et al. Coagulopathy related to dilution and hypotension during massive transfusion. Crit Care Med 1985; 13 (05) 387-391
    CrossrefPubMedGoogle Scholar
  • 23 Borgman MA, Spinella PC, Perkins JG. , et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 2007; 63 (04) 805-813
    CrossrefPubMedGoogle Scholar
  • 24 Perkins JG, Cap AP, Spinella PC. , et al. An evaluation of the impact of apheresis platelets used in the setting of massively transfused trauma patients. J Trauma 2009; 66 (4, Suppl): S77-S84 , discussion S84–S85 [corrected in “J Trauma 2009;67(6):1453” (Note: Andrew, Cap P [corrected to Cap, Andrew P]).]
    CrossrefPubMedGoogle Scholar
  • 25 Gunter Jr OL, Au BK, Isbell JM, Mowery NT, Young PP, Cotton BA. Optimizing outcomes in damage control resuscitation: identifying blood product ratios associated with improved survival. J Trauma 2008; 65 (03) 527-534
    CrossrefPubMedGoogle Scholar
  • 26 Sperry JL, Ochoa JB, Gunn SR. , et al; Inflammation the Host Response to Injury Investigators. An FFP:PRBC transfusion ratio >/=1:1.5 is associated with a lower risk of mortality after massive transfusion. J Trauma 2008; 65 (05) 986-993
    CrossrefPubMedGoogle Scholar
  • 27 Duchesne JC, Hunt JP, Wahl G. , et al. Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years?. J Trauma 2008; 65 (02) 272-276 , discussion 276–278
    CrossrefPubMedGoogle Scholar
  • 28 Duchesne JC, Islam TM, Stuke L. , et al. Hemostatic resuscitation during surgery improves survival in patients with traumatic-induced coagulopathy. J Trauma 2009; 67 (01) 33-37 , discussion 37–39
    CrossrefPubMedGoogle Scholar
  • 29 Gonzalez EA, Moore FA, Holcomb JB. , et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma 2007; 62 (01) 112-119
    CrossrefPubMedGoogle Scholar
  • 30 Watson GA, Sperry JL, Rosengart MR. , et al; Inflammation and Host Response to Injury Investigators. Fresh frozen plasma is independently associated with a higher risk of multiple organ failure and acute respiratory distress syndrome. J Trauma 2009; 67 (02) 221-227 , discussion 228–230
    CrossrefPubMedGoogle Scholar
  • 31 Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B. Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma 1997; 42 (05) 857-861 , discussion 861–862
    CrossrefPubMedGoogle Scholar
  • 32 Asensio JA, McDuffie L, Petrone P. , et al. Reliable variables in the exsanguinated patient which indicate damage control and predict outcome. Am J Surg 2001; 182 (06) 743-751
    CrossrefPubMedGoogle Scholar
  • 33 Asensio JA, Petrone P, Roldán G, Kuncir E, Ramicone E, Chan L. Has evolution in awareness of guidelines for institution of damage control improved outcome in the management of the posttraumatic open abdomen?. Arch Surg 2004; 139 (02) 209-214 , discussion 215
    CrossrefPubMedGoogle Scholar
  • 34 Johnson JW, Gracias VH, Schwab CW. , et al. Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma 2001; 51 (02) 261-269 , discussion 269–271
    CrossrefPubMedGoogle Scholar
  • 35 Duchesne JC, Kimonis K, Marr AB. , et al. Damage control resuscitation in combination with damage control laparotomy: a survival advantage. J Trauma 2010; 69 (01) 46-52
    CrossrefPubMedGoogle Scholar
  • 36 Roberts DJ, Bobrovitz N, Zygun DA. , et al. Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: a content analysis and expert appropriateness rating study. J Trauma Acute Care Surg 2015; 79 (04) 568-579
    CrossrefPubMedGoogle Scholar
  • 37 Stawicki SP, Brooks A, Bilski T. , et al. The concept of damage control: extending the paradigm to emergency general surgery. Injury 2008; 39 (01) 93-101
    CrossrefPubMedGoogle Scholar
  • 38 Midwinter MJ. Damage control surgery in the era of damage control resuscitation. J R Army Med Corps 2009; 155 (04) 323-326
    CrossrefPubMedGoogle Scholar
  • 39 Joseph B, Zangbar B, Pandit V. , et al. The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome. J Trauma Acute Care Surg 2014; 76 (02) 457-461
    CrossrefPubMedGoogle Scholar
  • 40 Pommerening MJ, DuBose JJ, Zielinski MD. , et al; AAST Open Abdomen Study Group. Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery 2014; 156 (02) 431-438
    CrossrefPubMedGoogle Scholar
  • 41 Hatch QM, Osterhout LM, Podbielski J. , et al. Impact of closure at the first take back: complication burden and potential overutilization of damage control laparotomy. J Trauma 2011; 71 (06) 1503-1511
    CrossrefPubMedGoogle Scholar
  • 42 Fox N, Crutchfield M, LaChant M, Ross SE, Seamon MJ. Early abdominal closure improves long-term outcomes after damage-control laparotomy. J Trauma Acute Care Surg 2013; 75 (05) 854-858
    CrossrefPubMedGoogle Scholar
  • 43 Lauerman MH, Dubose JJ, Stein DM. , et al. Evolution of fascial closure optimization in damage control laparotomy. Am Surg 2016; 82 (12) 1178-1182
    PubMedGoogle Scholar
  • 44 Pommerening MJ, Kao LS, Sowards KJ, Wade CE, Holcomb JB, Cotton BA. Primary skin closure after damage control laparotomy. Br J Surg 2015; 102 (01) 67-75
    CrossrefPubMedGoogle Scholar
  • 45 Higa G, Friese R, O'Keeffe T. , et al. Damage control laparotomy: a vital tool once overused. J Trauma 2010; 69 (01) 53-59
    CrossrefPubMedGoogle Scholar
  • 46 Martin MJ, Hatch Q, Cotton B, Holcomb J. The use of temporary abdominal closure in low-risk trauma patients: helpful or harmful?. J Trauma Acute Care Surg 2012; 72 (03) 601-606 , discussion 606–608
    CrossrefPubMedGoogle Scholar