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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Jens Hillingsø, University of Copenhagen, Denmark
- Second opponent: Professor Laura Green, Queen Mary University of London, UK
- Third member and chair of the evaluation committee: Professor Kjetil Sunde, University of Oslo
Chair of the Defence
Professor II Eirik Helseth, University of Oslo
Principal Supervisor
Christine Gaarder, University of Oslo
Summary
Injury remains one of the leading causes of death globally, with hemorrhage being a primary cause of early, potentially preventable trauma mortality.
Damage Control Resuscitation (DCR) with balanced transfusion has since 2006 consistently improved patient outcomes. However, the effects of DCR on patients with severe pelvic and liver injuries have not been thoroughly documented and studies still report high mortality rates for critically bleeding trauma patients.
The aim of this thesis was to determine whether the implementation of DCR has influenced treatment and outcomes in patients with pelvic and liver injuries, and in critically ill trauma patients at Oslo University Hospital.
For patients with pelvic injuries treated with DCR, there was a reduction in need for both extraperitoneal pelvic packing (EPP) and angiography, without affecting mortality.
After the implementation of DCR, a decline in the number of laparotomies and angioembolization (AE) procedures were noticed in patients with liver injuries. Additionally, the overall 30-day mortality rate decreased. Non-operative management proved safe for 70% of patients with high-grade injuries.
In the group of critically bleeding trauma patients the achievement of early balanced transfusions from 2014 (plasma/platelets to RBC ratios ≥1) has improved outcomes. Overall, the use of AE increased, emergency laparotomy rate declined with a concurrent reduction in all-cause mortality rates at 6 hours, at 24 hours, and at 30 days.
Contemporary resuscitation strategies have reduced the need for EPP and laparotomies for patients with severe pelvic and liver injuries with a concomitant reduction in AE. These strategies stabilized mortality rates for patients with pelvic injuries and lowered them for patients with liver injuries. Moreover, achieving balanced transfusion ratios within 6 hours significantly reduced all-cause mortality across multiple time points for critically ill trauma patients.
Additional information
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