An update in trauma resuscitation and critical care

Dr Jonathan Ball

The guiding principles of care for the seriously injured haven’t changed, but controversies remain.  Rapid expert response, a scoop-and-run philosophy with conveyance to a major trauma centre; damage control resuscitation; haemorrhage control / damage control surgery and continuous critical care are effective and having a meaningful impact on early outcomes.  Optimising components of this strategy is challenging as exemplified by the recent trials of pre-hospital plasma that have found apparently divergent results.  Tranexamic acid is effective and has been widely adopted but do we understand what it’s doing and how best to use it?  For extreme resuscitation scenarios the clamshell thoracotomy is giving way to endovascular balloon occlusion of the aorta but where are we on the enthusiasm verses experience curve?  There’s new Meccano for fixing ribs and a growing set of questions around in whom and when to deploy it.  The inflammasome-ologists are demonstrating that severe injury and severe infection have almost everything in common, including the emerging and complex story of organ cross-talk.  In the medium and long term these go on to cause fibrosis, accelerated organ aging and chronic multiple organ failure.  Finally, we need to discuss the slow tsunami of frailty related trauma.