Evolution of treatment principles of patients with gunshot wounds to uptodate damage control resuscitation strategy

Keywords: gunshot wound, treatment, damage control resuscitation, bleeding, transfusion, tranexamic acid


Introduction. The leading cause of death worldwide is trauma, including gunshot wounds, which kill about 5.8 million people annually. In particular, according to the Office of the UN High Commissioner for Human Rights, since the beginning of russia's full-scale war against Ukraine in 3 months of conflict, 8,189 civilians have died, 3,838 were killed and 4,351 wounded. Acute uncontrolled massive blood loss is a major complication and cause of death in trauma patients. According to the data, 50% of patients do not receive timely medical care and die before hospitalization, and 30% die within the next two hours after transportation to the intensive care unit. In view of the above, there is a need to implement a protocol that would prevent significant mortality in such patients. Damage control resuscitation (DCR) is a modern resuscitation strategy for the treatment of massive blood loss in injured patients. The basic principles of DCR include: permissible hypotension, restrictive infusion therapy, early blood transfusion, hemostatic resuscitation and empirical use of tranexamic acid (Tranexamic acid, TXA), prevention/correction of acidosis and hypothermia, Damage Control Surgery (DCS) and others.

The purpose. Analyze current data on the application of the DCR strategy to optimize resuscitation in patients with trauma and reduce mortality from uncontrolled bleeding.

Materials and methods. To obtain relevant information on the current management of trauma patients according to the DCR strategy, data from review articles, clinical trials, original articles, clinical recommendations in the following world information resources were used: PubMed, Scopus, Elsevier, ResearchGate, Cochrane Library, Science Direct, Free Medical Journals. Research methods such as historical, bibliosemantic, comparative analysis and systems approach were used.

Results. In this group of patients, it is recommended to keep the systolic blood pressure (CAT) from 80 to 100 mm Hg. Art. Restrictive infusion therapy involves delaying or limiting infusions of colloids and crystalloids to ensure reliable hemostasis and prevent dilution coagulopathy. The next key and important part of the DCR protocol is the early use of blood products, not taking into account haemoglobin. In the absence of bleeding control, additional transfusion of plasma, platelets and erythrocytes in a ratio of 1: 1: 1 or fresh whole blood, is considered the best method to restore bleeding losses, even in the prehospital stage. Empirical use of TXA reduces mortality in patients with blood loss compared with placebo. The DCR concept recognizes that the concomitant application of the DCR strategy with DCS provides the best results in the treatment of patients with bleeding from trauma.

Conclusions. Current data on the use of intensive care for serious injuries, including severe gunshot wounds, have been  analyzed in order to optimize resuscitation measures in patients with injuries and reduce mortality from uncontrolled bleeding. It has been shown that the strategy of DCR is more than one method or treatment, but rather a multi-component tactic that combines intensive care and surgical care. Such tactics focus on tolerable hypotension, restrictive infusion therapy, early prehospital blood transfusion, hemostatic resuscitation and empirical use of THA, prevention / correction of acidosis and hypothermia. It is emphasized that timely and correct use of DCR in combination with RDCR (at the prehospital level) improves survival, reduces the length of stay of patients in the intensive care unit, the incidence of long-term complications and mortality in such patients.

Author Biographies

M. P. Boichak, Ukrainian Military Medical Academy

DM DSc, Prof., Professor of Military Therapy Department, Major-general of the Medical Service, retired, Ukrainian Military Medical Academy

B. V. Yurchenko, Ukrainian Military Medical Academy

Student of the Faculty of Military Physicians Training, Lieutenant (junior grade) of the Medical Service, Ukrainian Military Medical Academy

V. M. Moshkivskyi, Ukrainian Military Medical Academy

Lieutenant Colonel of the Medical Service, Senior Lecturer, Department of Anesthesiology and Intensive Care, Ukrainian Military Medical Academy, Kyiv

O. O. Fedorova, Ukrainian Military Medical Academy

PhD, Assoc Prof, Associate professor of Military Therapy Department, Ukrainian Military Medical Academy


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How to Cite
Boichak, M. P., Yurchenko, B. V., Moshkivskyi, V. M., & Fedorova, O. O. (2022). Evolution of treatment principles of patients with gunshot wounds to uptodate damage control resuscitation strategy. Ukrainian Journal of Military Medicine, 3(2), 120-128. https://doi.org/10.46847/ujmm.2022.2(3)-120
Current aspects of diagnosis and treatment