Ritcha Saxena and Ljiljana V Vasovic
Trauma is the main cause of morbidity and mortality, accounting for 10% of all mortality globally. This is primarily due to the occurrence of hemorrhagic shock. Uncontrolled hemorrhage and its effects, including anemia, hypovolemia, and impaired organ perfusion, necessitate the use of appropriate transfusion and volume resuscitation. For many years, the mainstay of treating trauma-induced bleeding was replenishing lost coagulation factors. The logical belief that coagulopathy should be directly addressed throughout trauma resuscitation has recently been strengthened by a greater knowledge of the pathophysiology of coagulopathy in trauma patients. Crystalloid was originally considered the cornerstone in pre-hospital management of hemorrhagic shock but is now revealed to result in a multitude of complications that raise patient morbidity. The Damage Control Resuscitation (DCR) strategy includes balanced resuscitation, hemostatic resuscitation, and prevention of acidosis, hypothermia, and hypocalcemia for critical trauma patients. Fluid administration is limited during balanced resuscitation, and hypotension is maintained up until the start of definitive hemostatic treatments. The best preventive measure for trauma-induced coagulopathy, according to recent treatment standards, is permissive hypotension and controlled resuscitation. Even after studying randomized-controlled trials, systematic reviews and meta-analyses, the feasibility of permissive hypotension and similar strategies remains unclear. It is necessary to conduct additional research to determine massive transfusion protocols that would benefit all trauma patients, regardless of variables like age, injury mechanism, or the existence of hypotension.