Damage Control Resuscitation: Massive Transfusion Protocols and Pharmacologic Adjuncts

Over the last 400 years, the understanding and management of hemorrhagic shock has significantly evolved. The fundamental goal must be definitive hemorrhage control and trauma patients in shock mandate emergent evaluation by a surgeon. Resuscitation strategies in particular have seen many changes. Today there are numerous approaches in the management of hemorrhagic shock and multiple adjuncts have been proposed. The surrounding literature is extensive and complex. This review seeks to condense and summarize the plethora of concepts to make it more accessible to the practicing surgeon. It will explain modern damage control resuscitation, the various approaches to massive transfusion, and the numerous pharmacologic adjuncts.