The lessons learned regarding the
resuscitation of traumatic
hemorrhagic shock are numerous and come from a better understanding of the epidemiology, pathophysiology, and experience in this population over 10-plus years of combat operations. We have now come to better understand that the greatest benefit in survival can come from improved treatment of
hemorrhage in the prehospital phase of care. We have learned that there is an endogenous coagulopathy that occurs with severe traumatic injury secondary to
oxygen debt and that classic
resuscitation strategies for severe
bleeding based on
crystalloid or
colloid solutions exacerbate coagulopathy and
shock for those with life-threatening
hemorrhage. We have relearned that a whole blood-based
resuscitation strategy, or one that at least recapitulates the functionality of whole blood, may reduce death from
hemorrhage and reduce the risks of excessive
crystalloid administration which include
acute lung injury,
abdominal compartment syndrome,
cerebral edema, and
anasarca. Appreciation of the importance of
shock and coagulopathy management underlies the emphasis on early
hemostatic resuscitation. Most importantly, we have learned that there is still much more to understand regarding the epidemiology, pathophysiology, and the
resuscitation strategies required to improve outcomes for casualties with
hemorrhagic shock.