Hemostatic Resuscitation

Damage control resuscitation (DCR) is the combination of hemorrhage control and a hemostatic resuscitation strategy that emphasizes not only volume replacement and restoration of oxygen-carrying capacity to maintain cardiac output but also restoration of hemostatic potential. This approach ensures that resuscitation will work in concert with hemorrhage control rather than cause a dilution of hemostatic factors and platelets that worsens bleeding. Hemostatic resuscitation is the term used to describe a whole blood or a whole blood equivalent approach to resuscitating patients with traumatic hemorrhagic shock. Hemostatic resuscitation is the central tenant to DCR. This chapter will describe hemostatic resuscitation as the optimal treatment for trauma-induced blood failure. Improvements in component therapy, such as the introduction of hemostatically active cold-stored platelets, are also presented. The uses of viscoelastic testing, factor concentrates, antifibrinolytics, and other hemostatic adjuncts are also discussed.