Future strategies for remote damage control resuscitation after traumatic hemorrhage

One of the key elements of remote damage control resuscitation (RDCR) is a hemostatic resuscitation strategy to prevent the triad of coagulopathy, acidosis and hypothermia. Transfusion of whole blood has been an effective solution for both military and civilian patients, and appears to be superior to individual component therapy. At first, whole blood seems to be the ideal solution for RDCR, but it has some clinical and logistic drawbacks that may limit its use in the prehospital, battlefield, austere, and remote settings, or during multiple casualty or massive transfusion scenarios. The ideal resuscitation product for RDCR after traumatic hemorrhagic shock would be light-weight, long lasting, easily stored in large quantities, free from refrigeration, carry no risk of blood-borne infection or ABO-incompatibility, and carry out the same physiological functions as blood. Lyophilized plasma appears to fulfil many of these criteria, and is in current clinical use. There have been promising preclinical investigations of haemoglobin-based oxygen carriers (HBOC) and lyophilized platelet preparations, and one HBOC is in clinical use. It seems feasible that in the near future there may be a total blood substitution strategy for RDCR that is priority based, aimed at repaying the oxygen debt, restoration of the endothelium, and mitigation of coagulopathy and inflammatory dysregulation. Further preclinical and clinical research activity may facilitate such a resuscitation strategy that is equivalent—or perhaps even superior—to whole blood, but without any of its drawbacks. Type of article Current opinion Level of evidence Not applicable Address for corresponding author and reprints: Dr David Naumann, Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, B15 2SQ, UK. Email: david.naumann@nhs.net, Tel: +44 (0) 7861 242 807, Type of article: Current opinion Conflict of interest statement: The authors declare that they have no conflicts of interest. Although all authors are affiliated to the Royal Centre for Defence Medicine, their opinions are their own, and do not necessarily represent those of the UK Defence Medical Services. Funding: No specific funding was received for the writing of this “Current Opinion” article. © 2018 Lippincott Williams & Wilkins, Inc.

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