End-Points of Resuscitation

Abstract

Polytrauma is the leading cause of death during the first four decades of life. It is also a major cause of morbidity, requiring prolonged hospital care and entailing elevated treatment costs. Improvements in emergency transportation have increased the number of survivors on arrival at hospital, while emergency resuscitation and advanced surgical techniques, aided and directed by modern imaging processes, have reduced early mortality. There remains, however, a significant proportion of patients who suffer multiple organ dysfunction syndrome (MODS) at a later stage, and unfortunately many of these patients die. Improved early resuscitation techniques, including more aggressive practices, could conceivably help to prevent morbidity and mortality in such circumstances. Traumatic shock is characterized by a reduction in blood volume, resulting initially from a decrease in cardiac output followed promptly by a diminution in arterial blood pressure (ABP). These alterations provoke a sympathetic response, leading to peripheral vasoconstriction, increased heart rate, and decreased myocardial contractility. The subsequent redistribution of blood flow to vital organs results in reduced skin perfusion and decreased urinary output. Hence, assessment of adequate resuscitation is often based upon these parameters.