Vol. 1 No. 1 (2026)
Saudi Journal of Critical Care and General Medicine (SJCCGM)

Articles

Damage control resuscitation strategies in emergency department trauma patients: a systematic review

Published 2026-09-05

  • Mazi Mohammed Alanazi
    • ,
  • Fatimah Saud Alfaraj
    • ,
  • Najla AlkilaniI

Mazi Mohammed Alanazi
Saudi and Jordanian Board Emergency Medicine, Emergency Department, Head of Emergency Research Unit, First Health Cluster, Riyadh, Saudi Arabia ORCID: 0009-0003-5836-8086

Fatimah Saud Alfaraj
Saudi Board Emergency Medicine Resident, Emergency Department, First Health Cluster, King Saud Medical City, Riyadh, Saudi Arabia

Najla AlkilaniI
Saudi Board Emergency Medicine Resident, Emergency Department, First Health Cluster, King Saud Medical City, Riyadh, Saudi Arabia

Abstract

Background: Damage control resuscitation (DCR) integrates hemorrhage control with restricted crystalloid exposure, balanced hemostatic transfusion, antifibrinolytic therapy, permissive hypotension in selected patients, and physiology-guided correction of trauma-induced coagulopathy. Objective: In this systematic review we synthesized comparative studies on DCR strategies used during emergency management of adult trauma patients with major bleeding or hemorrhagic shock. Methods: A PRISMA-aligned framework was designed for PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library from inception through July 2026. Eligible studies evaluated early resuscitation interventions and reported mortality, hemostasis, transfusion exposure, coagulation outcomes, or adverse events. Randomized trials and comparative observational studies were analyzed narratively because interventions, settings, and endpoints were heterogeneous. Results: We included studies of restricted-volume resuscitation, balanced plasma-platelet-red cell transfusion, viscoelastic-guided hemostatic therapy, tranexamic acid, prehospital plasma, and whole blood. Balanced transfusion improved hemostasis and reduced death from exsanguination in a randomized trial without a significant difference in overall 24-hour or 30-day mortality. Tranexamic acid reduced bleeding-related mortality when given early in an international trial. Plasma trials produced discordant mortality findings across transport systems. Contemporary whole-blood evidence included favorable observational associations but no superiority over component therapy in a 2026 randomized trial. Conclusion: DCR is best supported as an integrated, time-critical strategy rather than a single product or fixed ratio.

Keywords

Damage control resuscitation, trauma, hemorrhagic shock, massive transfusion, tranexamic acid

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