The crystalloid fluid used in initial resuscitative efforts does not contain any clotting factors or erythrocytes. The recognition that fluid resuscitation might interfere with hemostatic mechanisms, ultimately exacerbating blood and coagulation factors loss, led to a re-evaluation of the former accepted concept that normal circulatory function is restored by aggressive crystalloids volume. The sequential strategy of operation followed by resuscitation has been replaced by an integrated approach so that resuscitation and surgery are undertaken simultaneously, with close communication and cooperation between surgeon and anesthetist (2-5). Therefore, DCR is designed to proceed hand in hand with damage control surgery. In a practical standpoint the vicious cycle of acidosis/ hypothermia/ coagulopathy must be aimed as potential lethal cycle and corrected immediately.ĭCR combines two seemingly diverse strategies - permissive hypotension and hemostatic resuscitation - with damage control surgery, integrating these three procedures in one dynamic process. The perpetuating combination of acute coagulopathy, hypothermia, and acidosis seen in exsanguinating trauma patients is a well-recognized term known as Lethal Triad (figure 1). For these patients the rapid and effective use of techniques to control bleeding and correction of this hemostatic derangement coined as Acute Coagulopathy of Trauma Shock (ACoTS) is essential. It should be mentioned that the majority of trauma patients do not require DCR and that its techniques should be reserved for those who are the most severely injured (2). Research in military and civilian populations regarding DCR have focused on ways to improve survival in patients with severe hemorrhage. Hemorrhage secondary to trauma accounts for 40% of trauma fatalities and comprises the leading cause of preventable death in trauma (1). Accepted concepts of trauma resuscitation and surgery have been challenged in the recent wars, and novel approaches have been developed to address the current complexity and severity of not only military trauma but also civilian conflicts.ĭamage control resuscitation (DCR) has become a topic of increasing relevance and popularity over the past several years. Conclusions: The presence of the lethal triad among patients with multiple trauma is associated with a higher mortality and ISS.Īcidosis Coagulation protein disorders Hypothermia Mortality Multiple trauma.In this Euroanesthesia #EA18 lecture Bruno Pereira (Campinas, Brazil) discusses the Damage control surgery Damage control surgeryīruno Pereira, Campinas, Brazil the word “war” refer to a bad feeling it is undeniable that military conflicts have always driven innovation and technical advances in medicine and surgery. The mean ISS among patients with and without the lethal triad was 31.7 and 25.6, respectively (p < 0.05). No death was recorded among the 74 patients without the lethal triad. Results: Twenty six patients had the lethal triad and 15% died in the emergency room within the first 6 hours. Body temperature, prothrombin time, partial thromboplastin time, platelet count and blood gases were determined on admission. Material and Methods: One hundred multiple trauma patients aged 26 to 56 years (90 males), admitted to an emergency room, were studied. Aim: To determine if the lethal triad in multiple trauma patients is associated with higher mortality and Injury Score Severity (ISS). Hypothermia, acidosis and coagulopathy are three complications in these patients, whose presence is known as lethal triad and indicates bad prognosis. 2013, 141, 11, pp.1420-1426.īackground: Patients who have suffered multiple traumatic injuries, have a serious risk for death. Prognostic value of the lethal triad among patients with multiple trauma.

Trauma triad of death