J.Jpn. Surg. Soc.. 120(3): 276-281, 2019

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Feature topic

DAMAGE CONTROL RESUSCITATION

Traumatology has developed with the history of treatment for those wounded in war in the USA, which forms the backbone of the management of trauma patients today. The popularization of the Japan Advanced Trauma Evaluation and Care (JATEC) protocol improved trauma care and management in Japan. However, the specificity of trauma care does not seem to be fully understood among Japanese general surgeons. The main cause of death of severe trauma patients is the collapse of circulation due to excessive blood loss. It is imperative to correct acute coagulopathy, metabolic aberrations, and organ damage induced by trauma and to control the bleeding quickly to save patients’ lives. Damage control surgery (DCS) has advanced from the early 1980s and has become the standard procedure to control bleeding and contamination quickly and efficiently in severe trauma. Damage control resuscitation (DCR) is a comprehensive treatment strategy for severe trauma patients, including not only DCS but also permissive hypotension and restrictive fluid administration, hemostatic resuscitation, etc., which has developed with the recent better understanding of the pathophysiology of trauma-associated coagulopathy. The future evolution of DCR and its appropriate application for severe trauma patients will further improve clinical results.

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