The United States Navy originally utilized the concept of damage control to describe the process of prioritizing the critical repairs needed to return a ship safely to shore during a maritime emergency. This concept of damage control management in crisis is well suited to the care of the critically ill trauma patient, and has evolved into the standard of care.

Damage control resuscitation is a group of strategies which address the lethal triad of coagulopathy, acidosis, and hypothermia. In this article, damage control resuscitation aims to limit blood loss and prevent coagulopathy by combining hypotensive resuscitation, early airway control, and early and balanced use of blood products and other hemostatic agents.

Fresh whole blood (FWB) is an attractive transfusion product as it contains all components required for coagulation. Moreover, the logistics of massive transfusion are streamlined as, in a hemorrhaging patient, FWB simply replaces lost blood in a single transfusion product.

FWB resuscitation was born out of necessity in military conflicts. During the early years of the wars in Iraq and Afghanistan, FWB was used during massive transfusion at combat support hospitals when blood components (especially perishable platelets) were scarce. The military maintains a “walking blood bank” of service members. FWB is a readily available balanced transfusion product for resuscitation of combat victims.

Retrospective analysis of 354 casualty patients demonstrated potential survival benefit of FWB in resuscitation. Both 24-hour survival and 30-day survival were improved in the group who received FWB compared to those who only received RBC, plasma and/or platelets. The mortality benefit of FWB may be from the potential deleterious effect of anticoagulant additives in stored component therapy.

The safety of FWB in both military and civilian settings is well documented. The risks of infectious disease transmission related to FWB transmission can be effectively mitigated with rapid pretransfusion screening tests. Cold stored whole blood was evaluated for use in a civilian academic level 1 trauma center as well. 47 patients were transfused a mean of 1.74 units of whole blood (mean age of the units was 7.74 days) without any adverse reactions.

Damage control is many strategies that combine resuscitation and surgical care, which focuses on rapid resuscitation with blood, rapid hemorrhage control, and correction of metabolic derangements. When correctly utilized it has been shown to improve survival, decrease length of stay, and improve outcomes.

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Keywords: Wounds and injuries; Advanced Trauma Life Support Care; Resuscitation; Blood Trans- fusion; Platelet Transfusion; Blood Component Transfusion; Infusions, Intravenous; Tranexamic Acid; Disorders, Blood Coagulation; Trauma, resuscitation, permissive hypotension, transfusion