Damage control resuscitation in combination with damage control laparotomy: A survival advantage

Juan C. Duchesne, Katerina Kimonis, Alan B. Marr, Kelly V. Rennie, Georgia Wahl, Joel Wells, Tareq M. Islam, Peter Meade, Lance Stuke, James M. Barbeau, John P. Hunt, Christopher C. Baker, Norman E. McSwain

Research output: Contribution to journalArticle

150 Citations (Scopus)

Abstract

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 ≥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.

Original languageEnglish (US)
Pages (from-to)46-52
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number1
DOIs
StatePublished - Jul 1 2010

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Resuscitation
Laparotomy
Survival
Erythrocytes
Intensive Care Units
Length of Stay
Blood Platelets
Hemorrhage
Injury Severity Score
International Normalized Ratio
Wounds and Injuries

Keywords

  • Adipose tissue
  • Body composition
  • Growth
  • Infant
  • Newborn
  • Obesity

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Damage control resuscitation in combination with damage control laparotomy : A survival advantage. / Duchesne, Juan C.; Kimonis, Katerina; Marr, Alan B.; Rennie, Kelly V.; Wahl, Georgia; Wells, Joel; Islam, Tareq M.; Meade, Peter; Stuke, Lance; Barbeau, James M.; Hunt, John P.; Baker, Christopher C.; McSwain, Norman E.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 69, No. 1, 01.07.2010, p. 46-52.

Research output: Contribution to journalArticle

Duchesne, JC, Kimonis, K, Marr, AB, Rennie, KV, Wahl, G, Wells, J, Islam, TM, Meade, P, Stuke, L, Barbeau, JM, Hunt, JP, Baker, CC & McSwain, NE 2010, 'Damage control resuscitation in combination with damage control laparotomy: A survival advantage', Journal of Trauma - Injury, Infection and Critical Care, vol. 69, no. 1, pp. 46-52. https://doi.org/10.1097/TA.0b013e3181df91fa
Duchesne, Juan C. ; Kimonis, Katerina ; Marr, Alan B. ; Rennie, Kelly V. ; Wahl, Georgia ; Wells, Joel ; Islam, Tareq M. ; Meade, Peter ; Stuke, Lance ; Barbeau, James M. ; Hunt, John P. ; Baker, Christopher C. ; McSwain, Norman E. / Damage control resuscitation in combination with damage control laparotomy : A survival advantage. In: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; Vol. 69, No. 1. pp. 46-52.
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abstract = "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 ≥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.",
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author = "Duchesne, {Juan C.} and Katerina Kimonis and Marr, {Alan B.} and Rennie, {Kelly V.} and Georgia Wahl and Joel Wells and Islam, {Tareq M.} and Peter Meade and Lance Stuke and Barbeau, {James M.} and Hunt, {John P.} and Baker, {Christopher C.} and McSwain, {Norman E.}",
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T1 - Damage control resuscitation in combination with damage control laparotomy

T2 - A survival advantage

AU - Duchesne, Juan C.

AU - Kimonis, Katerina

AU - Marr, Alan B.

AU - Rennie, Kelly V.

AU - Wahl, Georgia

AU - Wells, Joel

AU - Islam, Tareq M.

AU - Meade, Peter

AU - Stuke, Lance

AU - Barbeau, James M.

AU - Hunt, John P.

AU - Baker, Christopher C.

AU - McSwain, Norman E.

PY - 2010/7/1

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N2 - 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 ≥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.

AB - 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 ≥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.

KW - Adipose tissue

KW - Body composition

KW - Growth

KW - Infant

KW - Newborn

KW - Obesity

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