UAB Department of Surgery faculty are leading the way in education for trauma surgeons by creating guides for a new series published in the Journal of Trauma and Acute Care Surgery. Both pieces are “need to know” articles on damage control resuscitation (DCR) in both adult and pediatric trauma patient populations.
Danny Lammers, M.D., a second-year Trauma and Surgical Critical Care fellow, published “Damage Control Resuscitation in Adult Trauma Patients: What You Need to Know.”
Robert Russell, M.D., MPH, a professor in UAB’s Department of Surgery and director of Children’s of Alabama’s trauma program, published “Damage Control Resuscitation in Pediatric Trauma: What You Need to Know.”
Both pieces were chosen as the Editor’s Choice, Best of Trauma for the October 2023 issue of the journal, and Russell was invited to record a video summarizing his article.
The new “What You Need To Know” article series aims to supplement the journal’s cutting-edge research with educational, up-to-date guides summarizing information on topics related to the daily practice of acute care surgery. These guides will be the go-to reference for the topics they discuss.
What is damage control resuscitation?
The goal of DCR is to stabilize a trauma patient enough for surgery, and occurs prehospital and in the hospital. According to the Joint Trauma System, DCR “prioritizes non-surgical interventions to reduce morbidity and mortality from trauma and hemorrhage.”
As Lammers explains, DCR has several main principles: early blood product utilization, mitigation of crystalloid use, early hemorrhage control, and hypotensive resuscitation, in combination with damage-control surgery.
Damage control resuscitation in adult trauma patients
Lammers’ guide describes the history of DCR, from being proven as effective on the battlefield in recent wars, to being the standard of care in trauma resuscitation. They outline the “why” and “how” of DCR.
Lammers urged the trauma community to continue research into what the optimal strategy should be to care for trauma patients.
“Bleeding patients are still dying, thus continued efforts in this arena should remain a top research priority to help mitigate potentially preventable deaths from hemorrhagic shock,” the piece states.
The co-author of the piece is professor John Holcomb, M.D., FACS.
Read Lammers' full piece here.
Damage control resuscitation in pediatric trauma patients
Russell’s guide outlines principles of pediatric damage control, and includes a practical guide for implementing damage control resuscitation (DCR) for pediatric trauma patients.
Though principles used in pediatric and adult trauma patients are quite similar, there are important physiologic differences in children with traumatic hemorrhagic shock that warrant slight variations in DCR. The early physiologic signs of shock in pediatric trauma patients may be different from adults, and the review urges that “the early recognition of this is critical to enable prompt resuscitation and utilization of damage control principles.”
Russell ultimately makes the case for more clinical trials and better data collection to improve the care of children with life-threatening bleeding from traumatic injury.
Russell’s clinical interests include minimally invasive pediatric surgery, pediatric trauma, and neonatal surgery. His research interests focus on mechanisms and translational questions regarding acute traumatic coagulopathy in the pediatric trauma population as well as quality improvement and clinical outcomes in pediatric surgery.
The co-authors of the piece are Christine Leeper, M.D., and Philip Spinella, M.D.
Read Russell’s full piece here.
Watch Russell's video here.