Abstract

PETRONE, Patrizio et al. Factors predicting institution of damage control in the exanguination syndrome. rev. colomb. cir. [online]. 2007, vol.22, n.4, pp.192-201. ISSN 2011-7582.

Background: The objectives of this study were to investigate the relationship between survival and patient characteristics, such as vital signs, mechanisms of injury, and management, as well as to determine if levels of pH, temperature, and blood loss can predict survival. Materials and methods: A retrospective 72-month-study performed at Los Angeles County and University of Southern California Medical Center, including patients with diagnosis of exsanguination. Inclusion criteria: intraoperative blood loss of >2,000 ml, transfusion of packed red blood cells of >1,500 ml during the resuscitation period. Exclusion criteria: patients younger than 18 years old. Other information collected included age, gender, mechanisms of injury, vital signs on arrival, presence of spontaneous respiration, pulse, movements of the extremities, electrical cardiac activity, need of orotracheal intubation and cardio-pulmonar resuscitation. Injury Severity Score (ISS), Revised Trauma Score (RTS), and Glasgow Coma Scale (GCS) were also recorded. Analysis was made in two phases: -death vs. survival in Emergency Department (ED), and death vs. survival in operating room (OR). Analysis was performed using t-Student test. Results: 548 patients were identified. Penetrating injuries: 82% vs. blunt injuries: 18%. Vital signs in ED: mean systolic blood pressure 63±54 mm Hg (range: 30-198), mean heart rate 78±55 beats per minute (range: 18-180). Mean RTS: 4,38; mean ISS 32. Mean OR pH 7.15, and temperature 34.3°C. Mortality was 69% (379 out of 548). Analysis phase 1: Logistic regression. Independent risk factors for survival - penetrating trauma, spontaneous ventilation, and no ED thoracotomy (p<0.001). Analysis phase 2: Logistic regression. Independent risk factors for survival: ISS<20, spontaneous ventilation in ED, OR packed red blood cells replacement < 4,000 ml, no ED or OR thoracotomy, and absence of abdominal vascular injury (p<0.001). Conclusions: Survival rates can be predicted in this patient population. Damage control should be instituted following these guidelines.

Keywords : surgical blood loss; hemorrhage; laparotomy; guideline; wounds and injuries; survival.

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