Advertisement

Vascular Damage Control Techniques: What Do I Do When All Else Fails?

  • Chad G. BallEmail author
Chapter

Abstract

Damage control resuscitation (DCR) refers to an ongoing, mobile process that includes, but is not limited to, early blood product transfusion in the context of a massive transfusion protocol, minimization of crystalloid fluid administration, permissive hypotension, early transfer to the site needed to arrest hemorrhage, abbreviated operative or percutaneous intervention, sustained critical care, and a return for definitive surgical care when the patient is able. Ongoing hemorrhage in particular can be extremely challenging to manage. Damage control surgery may therefore also include the use of balloon catheter tamponade and/or placement of temporary intravascular shunts.

Keywords

Damage control Balloons TIVS Shunts Hemorrhage Hostile physiology 

References

  1. 1.
    Manual for Naval warfare. United States of America Navy. 1996.Google Scholar
  2. 2.
    Rotondo MF, Schwab CW, McGonigal MD, Phillips GR 3rd, Fruchterman TM, Kauder DR, et al. Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375–83.CrossRefPubMedGoogle Scholar
  3. 3.
    Lucas CE, Ledgerwood AM. Prospective evaluation of hemostatic techniques for liver injuries. J Trauma. 1976;16:442–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Calne RY, McMaster P, Pentlow BD. The treatment of major liver trauma by primary packing with transfer of the patient for definitive treatment. Br J Surg. 1979;66:338–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Feliciano DV, Mattox KL, Jordan GL Jr. Intra-abdominal packing for control of hepatic hemorrhage: a reappraisal. J Trauma. 1981;21:285–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg. 1983;197:532–5.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Firoozmand E, Velmahos GC. Extending damage control principles to the neck. J Trauma. 2000;48:541.CrossRefPubMedGoogle Scholar
  8. 8.
    Granchi T, Schmittling Z, Vasquez J, Schreiber M, Wall M. Prolonged use of intraluminal arterial shunts without systemic anticoagulation. Am J Surg. 2000;180:493–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN, et al. External fixation as a bridge to nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000;48:613–23.CrossRefPubMedGoogle Scholar
  10. 10.
    Vargo DJ, Battistella FD. Abbreviated thoracotomy and temporary chest closure: an application of damage control after thoracic trauma. Arch Surg. 2001;136:21–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Holcomb JB, Helling TS, Hirshber A. Military, civilian and rural application of the damage control philosophy. Mil Med. 2001;166:490–3.PubMedGoogle Scholar
  12. 12.
    Nicholas JM, Rix EP, Easley KA, Feliciano DV, Cava RA, Ingram WL, et al. Changing patterns in the management of penetrating abdominal trauma: the more things change, the more they stay the same. J Trauma. 2003;55:1095–108.CrossRefPubMedGoogle Scholar
  13. 13.
    Lier H, Krep H, Schroeder S, Stuber F. The influence of acidosis, hypocalcemia, anemia, and hypothermia on functional hemostasis in trauma. J Trauma. 2008;65:951–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Wyrzykowski AD, Feliciano DV. Trauma damage control. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 6th ed. New York: McGraw-Hill Medical; 2008. p. 851–70.Google Scholar
  15. 15.
    Cushman JG, Feliciano DV, Renz BM, Ingram WL, Ansley JD, Clark WS, et al. Iliac vessel injury: operative physiology related to outcome. J Trauma. 1997;42:1033–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62:307–10.CrossRefPubMedGoogle Scholar
  17. 17.
    Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;27:1105–9.CrossRefGoogle Scholar
  18. 18.
    Morrison CA, Carrick MM, Norman MA, et al. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J Trauma. 2011;70:652–63.CrossRefPubMedGoogle Scholar
  19. 19.
    Como JJ, Dutton RP, Scalea TM, Edelman BB, Hess JR. Blood transfusion rates in the care of acute trauma. Transfusion. 2004;44:809–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Brohi K, Singh J, Hern M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008;65:748–54.CrossRefPubMedGoogle Scholar
  22. 22.
    Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfuse affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;64:805–13.CrossRefGoogle Scholar
  23. 23.
    Dente CJ, Shaz BH, Nicholas JM, Harris RS, Wyrzykowski AD, Patel S, et al. Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center. J Trauma. 2009;66:1616–24.CrossRefPubMedGoogle Scholar
  24. 24.
    Sheldon GF, Lim RC, Blaisdell FW. The use of fresh blood in the treatment of critically injured patients. J Trauma. 1975;15:670–7.CrossRefPubMedGoogle Scholar
  25. 25.
    O’Keeffe T, Refaai M, Tchorz K, Forestner JE, Sarode R. A massive transfusion protocol to decrease blood component use and cost. Arch Surg. 2008;143:686–90.CrossRefPubMedGoogle Scholar
  26. 26.
    Snyder CW, Weinberg JA, McGwin G Jr, Melton SM, George RL, Reiff DA, et al. The relationship of blood product ratio to mortality: survival benefit or survival bias? J Trauma. 2009;66:358–62.CrossRefPubMedGoogle Scholar
  27. 27.
    Park PK, Cannon JW, Ye W, Blackbourne LH, Holcomb JB, Beninati W, et al. Transfusion strategies and development of acute respiratory distress syndrome in combat casualty care. J Trauma Acute Care Surg. 2013;75(S):S238–46.CrossRefPubMedGoogle Scholar
  28. 28.
    Inaba K, Branco BC, Rhee P, et al. Impact of plasma transfusion in trauma patients who do not require massive transfusion. J Am Coll Surg. 2010;210:957–65.CrossRefPubMedGoogle Scholar
  29. 29.
    Sharpe JP, Weinberg JA, Magnotti LJ, Fabian TC, Croce MA. Does plasma transfusion portend pulmonary dysfunction? A tale of two ratios. J Trauma Acute Care Surg. 2013;75:32–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Cotton BA, Guy JS, Morris JA, Abumrad NN. Cellular, metabolic, and systemic consequences of aggressive fluid resuscitation strategies. Shock. 2006;26:115–21.CrossRefPubMedGoogle Scholar
  31. 31.
    Rhee P, Koustova E, Alam HB. Searching for the optimal resuscitation method: recommendations for the initial fluid resuscitation of combat casualties. J Trauma. 2003;54:S52.CrossRefPubMedGoogle Scholar
  32. 32.
    Pruitt BA Jr. Protection for excessive resuscitation: “pushing the pendulum back”. J Trauma. 2000;49:567–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Ball CG, Kirkpatrick AW. Intra-abdominal hypertension and the abdominal compartment syndrome. Scand J Surg. 2007;96:197–204.CrossRefPubMedGoogle Scholar
  34. 34.
    Feliciano DV, Burch JM, Mattox KL, Bitondo CG, Fields G. Balloon catheter tamponade in cardiovascular wounds. Am J Surg. 1990;160:583–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Myhre JR. Balloon tamponade of hemorrhagic esophageal varices. Tidsskr Nor Laegeforen. 1958;78:511–3.PubMedGoogle Scholar
  36. 36.
    Taylor H, Williams E. Arteriovenous fistula following disk surgery. Br J Surg. 1962;50:47–50.CrossRefPubMedGoogle Scholar
  37. 37.
    Pearce CW, McCool E, Schmidt FE. Control of bleeding from cardiovascular wounds: balloon catheter tamponade. Ann Surg. 1966;166:257–9.CrossRefGoogle Scholar
  38. 38.
    Foster JH, Morgan CV, Threlkel JB. Proximal control of aorta with a balloon catheter. Surg Gynecol Obstet. 1971;132:693–4.PubMedGoogle Scholar
  39. 39.
    Sheldon GF, Winestock DP. Hemorrhage from open pelvic fracture controlled intraoperatively with balloon catheter. J Trauma. 1978;18:68–70.CrossRefPubMedGoogle Scholar
  40. 40.
    Belkin M, Dunton R, Crombie HD, Lowe R. Preoperative percutaneous intraluminal balloon catheter control of major arterial hemorrhage. J Trauma. 1988;28:548–50.CrossRefPubMedGoogle Scholar
  41. 41.
    Brendahan J, Swanepoel E, Muller R. Tamponade of vertebral artery bleeding by Foley’s catheter balloon. Injury. 1994;25:473–4.CrossRefGoogle Scholar
  42. 42.
    Smiley K, Perry MO. Balloon catheter tamponade of major vascular wounds. Am J Surg. 1971;121:326–7.CrossRefGoogle Scholar
  43. 43.
    Morimoto RY, Birolini D, Junqueira AR Jr, Poggetti R, Horita LT. Balloon tamponade for transfixing lesions of the liver. Surg Gynecol Obstet. 1987;164:87–8.PubMedGoogle Scholar
  44. 44.
    DiGiacomo JC, Rotondo MF, Schwab CW. Transcutaneous balloon catheter tamponade for definitive control of subclavian venous injuries: case reports. J Trauma. 1994;37:111–3.CrossRefPubMedGoogle Scholar
  45. 45.
    Sing RF, Sue SR, Reilly PM. Balloon catheter tamponade of exsanguinating facial hemorrhage: a case report. J Emerg Med. 1998;16:601–2.CrossRefPubMedGoogle Scholar
  46. 46.
    Navsaria P, Thoma M, Nicol A. Foley catheter balloon tamponade for life-threatening hemorrhage in penetrating neck trauma. World J Surg. 2006;30:1265–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Ball CG, Wyrzykowski AD, Nicholas JM, Rozycki GS, Feliciano DV. A decade’s experience with balloon catheter tamponade for the emergency control of hemorrhage. J Trauma. 2011;70:330–3.CrossRefPubMedGoogle Scholar
  48. 48.
    Frykberg ER, Schinco MA. Peripheral vascular injury. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 6th ed. New York: McGraw-Hill Medical; 2008. p. 956–7.Google Scholar
  49. 49.
    Eger M, Golcman L, Goldstein A, Hirsch M. The use of a temporary shunt in the management of arterial vascular injuries. Surg Gynecol Obstet. 1971;132:67–70.PubMedGoogle Scholar
  50. 50.
    Makins GH. Gunshot injuries to the blood vessels. London: Simpkin, Marshall, Hamilton, Kent & Co; 1919. p. 109–11.Google Scholar
  51. 51.
    Tuffier JT. French surgery in 1915. Br J Surg. 1916;4:420–32.CrossRefGoogle Scholar
  52. 52.
    Matheson NM, Murray G. Recent advances and experimental work in conservative vascular surgery. In: Bailey H, editor. Surgery of modern warfare, vol. 1. Baltimore: Williams and Wilkins; 1941. p. 324–7.Google Scholar
  53. 53.
    Ding W, Wu X, Li J. Temporary intravascular shunts used as a damage control surgery adjunct in complex vascular injury: collective review. Injury. 2008;39:970–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Ball CG, Feliciano DV. Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation? J Trauma. 2010;68:1117–20.CrossRefPubMedGoogle Scholar
  55. 55.
    Ball CG, Kirkpatrick AW, Rajani RR, Wyrzykowski AD, Dente CJ, Vercruysse GA, et al. Temporary intravascular shunts (TIVS): when are we really using them according to the NTDB? Am Surg. 2009;75:605–7.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Hepatobiliary and Pancreatic Surgery, Trauma and Acute Care SurgeryUniversity of Calgary, Foothills Medical CentreCalgaryCanada

Personalised recommendations