Start date
07/01/2009
Primary investigator
Juan C Duchesne
jduchesn@tulane.edu
(504) 988-5111
1430 Tulane Ave., SL-22
New Orleans, LA 70112-2699
Number of sites
5
Existing site names
Charity Hospital, Tulane and LSU-NO
Sponsoring organization
None
Abstract
Damage control resuscitation (DCR), a concept that has been popularized by the military, is now being evaluated for its applicability in the civilian setting. With DCR, systolic blood pressure is maintained around 90 mmHg, and isotonic crystalloid use is limited or nonexistent as blood products are transfused at a fixed ratio of one unit of fresh frozen plasma (FFP) for every unit of packed red blood cells (PRBC). This Hemostatic Transfusion Ratio (HTR) resuscitation strategy differs from current approaches by attempting an aggressive correction of the Acute Coagulopathy of Trauma Shock (ACoTS) during the initial steps of damage control interventions at ground zero. The resuscitation efforts begin in the field, then in the emergency room and continue through the operating room and into the intensive care unit. The concept centers on the fact that ACoTS can present early after injury in 25% of severely injured patients with a four-fold increase in mortality. Early diagnosis and interventions to correct ACoTS may lead to improved outcomes as reported from our institution retrospective study. Only retrospective evidence have demonstrated a survival benefit when a close HTR for FFP to PRBC is accomplish within the first hours after injury. Although the HTR have changed the resuscitation strategy with improved outcomes for those patients with severe hemorrhage, concern still exist regarding the adverse effects of blood products on patient morbidity. The purpose of this prospective observational study is to better delineate the benefits and/or potential adverse outcomes of HTR on patients with intra-operative severe hemorrhage (defined as >10 units of PRBC intra-operative transfusion) managed with Damage Control Surgery (DCS). •Primary outcome: Impact of HTR on patient mortality •Secondary outcomes: incidence of ARDS, Sepsis, MSOF SICU LOS, Hospital LOS, Ventilator free days, Days until final abdominal wall closure, Hospital disposition.