Comparison between damage control resuscitation and traditional treatment in resuscitation of elderly trauma patients in an Emergency Department, Egypt

Background
In the recent decade, a new paradigm in early trauma resuscitation, especially in case of ongoing, uncontrollable bleeding, has emerged. This paradigm change stresses on damage control resuscitation, a combination process of hypotensive resuscitation, hemostatic resuscitation, damage control surgery, and damage control radiology. This study was designed to determine the effect of damage control resuscitation, especially hypotensive resuscitation, as a factor in improving the outcome in traumatized elderly patients because vigorous fluid resuscitation is associated with rebleeding and a high mortality rate.
Aim
This study was conducted to improve the resuscitation process and decrease the mortality rate of elderly patients with trauma in the Department of Emergency.
Patients and methods
This comparative cross-sectional study included elderly patients with trauma (>65 years old) presenting with traumatic hypovolemic shock who were admitted to the Department of Emergency of Suez Canal University Hospital according to the inclusion and exclusion criteria. The patients were divided into two groups: group 1 received damage control resuscitation with hypotensive resuscitation, with the targeted systolic blood pressure being 90 mmHg, and group 2 received traditional treatment, with the targeted systolic blood pressure being 100 mmHg.
Results
After resuscitation, patients in the damage control resuscitation group had significantly less severe base deficit than those in group 2 (=0.04). Meanwhile, regarding coagulopathy, patients in the damage control resuscitation group had significantly lower international normalized ratio (<1.5) than those in group 2 (<0.001). Moreover, we found that patients who took damage control resuscitation had less mortality in the emergency room (21.6%) than those in group 2 (35.1%) (=0.04).
Conclusion
The study reported a lower rate of mortality and acid deficit in the group managed by damage control resuscitation. The results regarding the benefits of hypotensive resuscitation in elderly patients with trauma are optimistic. However, many confirmatory studies need to be conducted.