Radiologie (Heidelberg, Germany) · 2024
[Surgical management of severe noncompressible torso and organ hemorrhages].
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Maegele Marc
Аннотация
BACKGROUND: Noncompressible torso hemorrhages (NCTH) are now recognized as the leading cause of preventable death in the context of severe military and civilian injuries. Approximately 20% of all trauma patients still die from uncontrolled bleeding associated with rapidly evolving disorders of blood coagulation function.
OBJECTIVE: Summary of recent advances in the field of nonsurgical and surgical management, presentation of current treatment concepts and future research directions.
MATERIAL AND METHODS: Selective literature review and analysis.
RESULTS: The concepts for the early treatment of NCTH have considerably evolved over the last decade. The updated definition of NCTH includes a combination of high-grade anatomic body trunk injury, hemodynamic instability, urgent need for hemorrhage control, and aggressive hemostatic treatment. The treatment concepts consider the following 3 aspects: controlling the source of bleeding (close the tap), maintaining organ perfusion and restoring hemostasis (fill the tank) and increasing the body's resistance to ischemia (upgrade the armor). New tools, well-established damage control concepts and early and aggressive therapeutic intervention for hemostatic failure have significantly improved the outcomes.
CONCLUSION: Future research needs to refine and validate the current concepts for further clinical application.
OBJECTIVE: Summary of recent advances in the field of nonsurgical and surgical management, presentation of current treatment concepts and future research directions.
MATERIAL AND METHODS: Selective literature review and analysis.
RESULTS: The concepts for the early treatment of NCTH have considerably evolved over the last decade. The updated definition of NCTH includes a combination of high-grade anatomic body trunk injury, hemodynamic instability, urgent need for hemorrhage control, and aggressive hemostatic treatment. The treatment concepts consider the following 3 aspects: controlling the source of bleeding (close the tap), maintaining organ perfusion and restoring hemostasis (fill the tank) and increasing the body's resistance to ischemia (upgrade the armor). New tools, well-established damage control concepts and early and aggressive therapeutic intervention for hemostatic failure have significantly improved the outcomes.
CONCLUSION: Future research needs to refine and validate the current concepts for further clinical application.