Damage Control Management: from the surgical concept to multidisciplinary care for selected patients

Jean-Paul Lechat Published in the journal : September 2019 Category : Anesthésie-Réanimation

Initially considered specific for the severe polytraumatized patients, the concept of damage control (DC) has been extended to the acute medicine domain with a climax attained following recent attacks. As a result, this condition now mobilizes a series of actors from the chain of care.

In the pre-hospital setting, the DC with its requirement of early bleeding control consisting of setting a tourniquet and a pelvic belt has modified the ABC trilogy into C-ABC: "Control hemorrhages first", prior to "Airway - Breathing - Circulation". In the emergency setting, during the "golden hour", the team leader must assume four different tasks: supervise the lifesaving procedures, initiate the massive transfusion protocols, limit any additional workup to the essentials, and schedule the priority of the surgical action order.

In the operating room, the carrying out of interventions aimed at controlling bleeding and microbial contamination, along with tolerating unstandardized parameters except for temperature control upon admission, must be performed in the second hour, the speed of surgery being now the priority. In the ICU, homeostasis restoration within 36 hours should enable a secondary surgical procedure for anatomical and functional purposes to be conducted. At times, maybe even often, several intermediary interventions are necessary in order to perfectly control the hemorrhage and infection prior to undertaking the final surgery.

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