Damage Control Resuscitation: Evidence-based Systematic Review for Treating Traumatized Patients

Abstract

Aim: The aim of this study is to analyze concepts and updates on Damage Control Resuscitation (DCR), focusing on critical patient approaches, therapeutic failures identification, and the relevance of damage control in trauma. Methods: This article presents a systematic review of damage control resuscitation in trauma, encompassing both consolidated and emerging literature, using informative tables in accordance with PRISMA 2020 guidelines. Conducted between March 2023 and March 2024, using the research descriptor "Resuscitation for damage control" in PubMed. Studies published between 2016 and 2023, freely accessible in English and Portuguese, were included, while those not aligning with the objective were excluded. Out of 979 articles found, 10 were selected after applying inclusion and exclusion criteria. Results: Damage Control Resuscitation (DCR) is based on three pillars: permissive hypotension, minimization of crystalloid use, and balanced resuscitation. This approach aims to maintain adequate blood pressure, limit crystalloid use to avoid complications, and balance blood product transfusion. Hypocalcemia has emerged as a new challenge in the lethal triad of trauma, impacting coagulation and mortality. New techniques, such as REBOA and viscoelastic tests (TEG and ROTEM), are being explored to improve resuscitation in severe trauma cases. Tranexamic acid (TXA) also stands out as an effective treatment for excessive bleeding in trauma situations. The importance of pre-hospital care and early interventions is emphasized to optimize bleeding control and resuscitation in traumatized patients. Conclusion: Damage Control Resuscitation (DCR) is an evidence-based strategy for treating traumatized patients, focusing on permissive hypotension, reduced crystalloid use, and balanced transfusion. In resource-limited settings, alternatives such as whole blood use can be adopted. Pre-hospital care and early interventions are crucial for better outcomes and survival.