Innovations in preoperative control of exsanguination in major trauma

Exsanguination places a considerable strain on trauma systems worldwide, and is estimated to be involved in 20–40% of trauma deaths. This article evaluates innovations in the preoperative care of the injured patient to minimise the impact of bleeding. These include reform of organisations and structure of trauma networks, adoption of objective prehospital triage tools and changes in ambulance crews' approach to on-scene interventions. Developments of methods to mechanically control these bleeds—simple tourniquets, topical haemostatics developed in military settings and endovascular interventions such as resuscitative endovascular balloon occlusion of the aorta—are also analysed. This article has examined advancements in damage control resuscitation, including a possible future shift towards whole-blood transfusion and interventional radiology for primary haemorrhage control. Finally, a potential further development—the uptake of hybrid resuscitation suites—is examined.

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