• Behrouz Heidary, Nathaniel Bell, Jacqueline T Ngai, Richard K Simons, Kate Chipperfield, and S Morad Hameed.
• Department of Surgery, University of British Columbia, Trauma Services, Vancouver General Hospital, 855 W 12 Ave., Vancouver, British Columbia, V5Z 1M9 Canada.
• Am. J. Surg. 2012 May 1;203(5):568-73.

BackgroundThis study examined the evolution of damage control resuscitation (DCR) and outcomes in severe traumatic hemorrhage (STH) at a large Canadian trauma center.MethodsThis was a retrospective cohort study of trauma patients admitted to a level 1 trauma center between 2005 and 2010, who received 10 or more units of packed red blood cells within 24 hours of admission. Demographic and clinical findings were compared between survivors and nonsurvivors.ResultsForty-five patients were included. Twenty-five percent of patients were coagulopathic at admission. Early crystalloid use declined over the study period. The mean 24-hour fresh-frozen plasma:platelets:packed red blood cells ratio was 1:1:2. Hemorrhage-related mortality was 69%. No pedestrians survived STH. A total of 1,032 blood product units were used in the first day for nonsurvivors.ConclusionsPrinciples of DCR crept into clinical practice even before the implementation of a formal STH protocol. DCR appeared to reduce the intensive care unit length of stay but not mortality. STH is associated with heavy use of blood bank resources and high mortality rates. Futility of resuscitative efforts may be predictable by mechanism and early physiological markers.Copyright © 2012 Elsevier Inc. All rights reserved.

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