Our Strategy for Controlling Exsanguinating Abdominal Hemorrhage, “Damage Control Resuscitation with Damage Control Surgery”

Abstract

Our strategy for the treatment of hemorrhagic shock associated with abdominal organ injuries is as follows. If the patient is hemodynamically stable and a suitable candidate for enhanced CT, it is possible to take into account the findings of angiography and TAE. If the patient is hemodynamically unstable, or has gradually worsening hemorrhage, it is an absolute indication for Damage Control Surgery (DCS), and an ER laparotomy should be scheduled as soon as possible. Our three years’ experience of trauma laparotomy includes 104 cases, of which 42 underwent DCS. We conducted a retrospective analysis of the vital signs, management strategy, time management, and outcomes of these cases. The RTS was significantly lower, the ISS significantly higher, and the Ps significantly lower in the cases that had undergone DCS than in those in which DCS had not been performed. The most severe trauma group in our experience was the group of “Damage Control Resuscitation (DCR) with DCS” cases. The urgency was greater, the time duration from ER arrival to laparotomy was shorter, and the severity was greater in the ERL group than in the ORL group, although there were no significant differences among the groups. There were 8 unexpected survivors during this period, including 4 cases of aortic cross clamp for impending cardiac arrest. Our strategy for severe abdominal injury was properly complied with, and our clinical outcomes could be considered as acceptable.