Nach Abschluss des „Primary Survey“ eines Schwerverletzten muss im Schockraum eine
kritische Behandlungsentscheidung getroffen werden: Eignet sich der Patient für eine
frühe endgültige operative Versorgung („Early total Care“) seiner Verletzungen? Oder
erscheint er zu instabil, sodass zunächst nur unmittelbar lebensrettende Eingriffe
zur Blutungs- und Kontaminationskontrolle möglich sind („Damage Control Surgery“)?
Abstract
Trauma triggers complex physiological responses with primary and secondary effects
vital to understanding and managing trauma impact. “Damage Control” (DC), a concept
adapted from naval practices, refers to abbreviated initial surgical care focused
on controlling bleeding and contamination, critical for the survival of severely compromised
patients. This impacts anaesthesia procedures and intensive care. “Damage Control
Resuscitation” (DCR) is an interdisciplinary approach aimed at reducing mortality
in severely injured patients, despite potentially increasing morbidity and ICU duration.
Current medical guidelines incorporate DC strategies.
DC is most beneficial for patients with severe physiological injury, where surgical
trauma (“second hit”) poses greater risks than delayed treatment. Patient assessment
for DC includes evaluating injury severity, physiological reserves, and anticipated
surgical and treatment strain. Inadequate intervention can worsen trauma-induced complications
like coagulopathy, acidosis, hypothermia, and hypocalcaemia.
DCR focuses on rapidly restoring homeostasis with minimal additional burden. It includes
rapid haemostasis, controlled permissive hypotension, early blood transfusion, haemostasis
optimization, and temperature normalization, tailored to individual patient needs.
“Damage Control Surgery” (DCS) involves phases like rapid haemostasis, contamination
control, temporary wound closure, intensive stabilization, planned reoperations, and
final wound closure. Each phase is crucial for managing severely injured patients,
balancing immediate life-saving procedures and preparing for subsequent surgeries.
Intensive care post-DCS emphasizes stabilizing patients hemodynamically, metabolically,
and coagulopathically while restoring normothermia. Decision-making in trauma care
is complex, involving precise patient assessment, treatment prioritization, and team
coordination. The potential of AI-based decision support systems is noted for their
ability to analyse patient data in real-time, aiding in decision-making through evidence-based
recommendations.
Schlüsselwörter
Damage Control Resuscitation - Damage Control Surgery - Polytrauma - Schock - Intensivmedizin
Keywords
damage control resuscitation - damage control surgery - multiple trauma - shock -
intensive care medicine
