Patient Blood Management Guidelines: Module 1

Critical Bleeding Massive Transfusion

| Background |

3.5 Early surgical management

It is essential to stop bleeding as soon as possible. This can be achieved using compression, tourniquet, packing, surgical control, embolisation or topical haemostatic agents, or a combination of these approaches.

Damage control surgery refers to the timely use of a staged approach in the treatment of the actively bleeding shocked patient. This approach emphasises control of bleeding and prevention of further contamination, to allow the correction of hypothermia, coagulopathy and acidosis before definitive surgery is undertaken.35

There are five critical decision-making stages in damage control surgery:36

  • Stage 1: Early patient selection
  • Stage 2: Abbreviated life-saving surgery
  • Stage 3: Secondary resuscitation
  • Stage 4: Deferred definitive surgery
  • Stage 5: Reconstructive surgery, if required

Damage control principles have been applied in abdominal trauma, neurosurgery,34 chest trauma,37 spinal trauma,38 pelvic fractures,39 injuries to the extremities40 and physiologically compromised non-trauma patients.41

Damage control surgery may be indicated for patients with severe haemorrhagic shock. The decision to switch over to damage control mode should be made early.