Control of major haemorrhage and damage control surgery

Major haemorrhage is defined as ‘life-threatening bleeding’. It is associated with significant morbidity and mortality and prompt, expeditious control of haemorrhage is essential to improve patient outcome. Understanding the mechanism of injury in trauma and a systematic approach to clinical examination and assessment of blood loss are essential to identify the patient with a life-threatening bleed. Permissive hypotension, correction of coagulopathy and avoidance of hypothermia are important during the resuscitation phase. Special investigations for major haemorrhage are reserved for the haemodynamically stable patient. There are some generic surgical principles, which apply to all scenarios of major haemorrhage, and endovascular interventions have added a further dimension to this management strategy. Recent advances in survivability following polytrauma are credited to the modern concept of an integrated approach to damage control resuscitation and damage control surgery. This article aims to discuss some of these key principles that govern the management of the patient with major haemorrhage.