DAMAGE CONTROL RESUSCITATION

SUMMARY OF UPDATES

RAPID UPDATES

Aug 2023: Calcium caution statement added.

Jun 2023

- Calcium administration changed to 1 gram calcium.
- Tranexamic acid (TXA) 2gm bolus is now favored over the traditional 1gm prehospital bolus followed by 1gm infusion over 8 hours. The 2gm TXA bolus should be given as close to the time of injury as possible and not outside of the 3 hours window.

Jul 2019

- Greater emphasis on the use of Low Titer O Whole Blood (LTOWB) as the optimal strategy to deliver a balanced and maximally hemostatic resuscitation, with platelet functionality,
- Risk factors for massive transfusion (MT), International Normalized Ratio (INR) threshold updated to > 5.
- Earlier calcium use One gram of calcium IV/IO should be given to patients in hemorrhagic shock during or immediately after transfusion of the first unit of blood product and with ongoing resuscitation after every 4 units of blood products. Ideally, ionized calcium should be monitored and calcium should be given for ionized calcium less than 1.2mmol/L.1-5
- Blood pressure goals for DCR have been adjusted to a target systolic blood pressure (SBP) goal of 100 mmHg (110mmHg for traumatic brain injury (TBI)).
- Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) updated as a fielded option for the control of non-compressible torso hemorrhage. REBOA continues to be recommended for designated resuscitation teams and NOT intended to be used by the combat medic or
- The use of hydroxyethyl starch (Hextend, Hespan) as a resuscitation fluid is NO LONGER RECOMMENDED and has been removed from the
- The use of recombinant human activated factor VII (rhFVIIa) is no longer