Published 5 June 2009, doi:10.1136/bmj.b1778
Cite this as: BMJ 2009;338:b1778

Clinical Review

Damage control resuscitation for patients with major trauma

Jan O Jansen, consultant surgeon1, Rhys Thomas, consultant anaesthetist1, Malcolm A Loudon, consultant surgeon2, Adam Brooks, senior lecturer in military surgery and trauma3

1 16 Medical Regiment, Royal Army Medical Corps , 2 306 Hospital Support Medical Regiment, Royal Army Medical Corps , 3 Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Royal Army Medical Corps

J Jansen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN jan.jansen@nhs.net

The first 150 words of the full text of this article appear below.


Trauma resuscitation must address all three components of the "lethal triad": coagulopathy; acidosis; and hypothermia
Damage control resuscitation integrates permissive hypotension, haemostatic resuscitation, and damage control surgery
Coagulopathy is common in patients with haemorrhagic shock
In trauma patients predicted to require massive transfusion, administration of fresh frozen plasma, packed red blood cells, and platelets in a 1:1:1 ratio (of individual units) is associated with improved survival
Recombinant factor VIIa, cryoprecipitate, and tranexamic acid can be considered adjunctive treatments for coagulopathy
Damage control surgery is a surgical strategy aimed at restoring normal physiology rather than anatomical integrity; however, this component of damage control resuscitation should not be applied in isolation


Military conflict has always driven innovation and technical advances in medicine and surgery. Accepted concepts of trauma resuscitation and surgery have been challenged in the wars in Iraq and Afghanistan, and novel approaches have been developed to address the current complexity . . . [Full text of this article]


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