Haemorrhage control in severely injured patients

Russell L. Gruen, Karim Brohi, Martin Schreiber, Zsolt J. Balogh, Veronica Pitt, Mayur Narayan, Ronald V. Maier

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Most surgeons have adopted damage control surgery for severely injured patients, in which the initial operation is abbreviated after control of bleeding and contamination to allow ongoing resuscitation in the intensive-care unit. Developments in early resuscitation that emphasise rapid control of bleeding, restrictive volume replacement, and prevention or early management of coagulopathy are making definitive surgery during the first operation possible for many patients. Improved topical haemostatic agents and interventional radiology are becoming increasingly useful adjuncts to surgical control of bleeding. Better understanding of trauma-induced coagulopathy is paving the way for the replacement of blind, unguided protocols for blood component therapy with systemic treatments targeting specific deficiencies in coagulation. Similarly, treatments targeting dysregulated inflammatory responses to severe injury are under investigation. As point-of-care diagnostics become more suited to emergency environments, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products. Our Series paper describes how our understanding of the roles of the microcirculation, inflammation, and coagulation has shaped new and emerging treatment strategies.

Original languageEnglish (US)
Pages (from-to)1099-1108
Number of pages10
JournalThe Lancet
Volume380
Issue number9847
DOIs
StatePublished - Jan 1 2012

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Hemorrhage
Resuscitation
Point-of-Care Systems
Interventional Radiology
Wounds and Injuries
Hemostatics
Therapeutics
Microcirculation
Intensive Care Units
Emergencies
Inflammation
Surgeons

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gruen, R. L., Brohi, K., Schreiber, M., Balogh, Z. J., Pitt, V., Narayan, M., & Maier, R. V. (2012). Haemorrhage control in severely injured patients. The Lancet, 380(9847), 1099-1108. https://doi.org/10.1016/S0140-6736(12)61224-0

Haemorrhage control in severely injured patients. / Gruen, Russell L.; Brohi, Karim; Schreiber, Martin; Balogh, Zsolt J.; Pitt, Veronica; Narayan, Mayur; Maier, Ronald V.

In: The Lancet, Vol. 380, No. 9847, 01.01.2012, p. 1099-1108.

Research output: Contribution to journalArticle

Gruen, RL, Brohi, K, Schreiber, M, Balogh, ZJ, Pitt, V, Narayan, M & Maier, RV 2012, 'Haemorrhage control in severely injured patients', The Lancet, vol. 380, no. 9847, pp. 1099-1108. https://doi.org/10.1016/S0140-6736(12)61224-0
Gruen RL, Brohi K, Schreiber M, Balogh ZJ, Pitt V, Narayan M et al. Haemorrhage control in severely injured patients. The Lancet. 2012 Jan 1;380(9847):1099-1108. https://doi.org/10.1016/S0140-6736(12)61224-0
Gruen, Russell L. ; Brohi, Karim ; Schreiber, Martin ; Balogh, Zsolt J. ; Pitt, Veronica ; Narayan, Mayur ; Maier, Ronald V. / Haemorrhage control in severely injured patients. In: The Lancet. 2012 ; Vol. 380, No. 9847. pp. 1099-1108.
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