DCR consists of utilization of resuscitation strat­egies that attempt to limit secondary blood loss and prevent the development of coagulopathy. It should start immediately during patient initial evaluation and should continue through the entire resuscitation phase. The principles of DCR are in consonant with damage control surgery. Use of this approach should start with control of bleed­ing, use of blood products, early activation of the massive transfusion protocol (MTP), and hemo­static agents [11–17].

Hemostatic adjuvants that have shown effec­tive in the correction of acquired coagulopathy of trauma are tranexamic acid (TXA) [28–31]. We recommend the use of the use of TXA in bleeding trauma patients, and it is part of our MTPs. Prothrombin complex concentrates (PCCs) have been used in selected bleeding patients to correct warfarin, Direct Oral Anticoagulants (DOACS), and clinical conditions associated with elevated

INR especially in bleeding patients and patients with documented bleeding in head CT, but clini­cal data have failed to demonstrate decreased mortality [32, 33].

Signicantly less frequently, DC is done in iso­lated chest injuries, with exception for a short period of DC during emergency resuscitative tho­racotomy, clamping the pulmonary hilum, or twisting the lung along its hilar axis to stop bleed­ing from the pulmonary parenchyma [41–43]. DCS in thoracic trauma is frequently performed mostly by trauma surgeons, but not as often as DCL. Damage control surgery in thoracic trauma (DCTS) is indicated in cases of severe chest trauma with signicant physiological exhaustion, non-compressible torso hemorrhage, multiple bleeding sources, high injury scores, or impend­ing physiological deterioration, and it is per­formed alone or in combinations with damage control laparotomy (Figs. 12.2 and 12.3). The primary goal is to stabilize the patient rapidly, control bleeding, and minimize complications through lung-sparing techniques, repair of vascu­lar structures, and intrathoracic packing. The decision to perform DCTS considers the urgency of bleeding control, available resources, and the expertise of the surgical team to optimize patient outcomes in complex thoracic injuries. In a recent publication, combining 14 studies with a total of 211 patients, the authors reported that, intratho­racic packing was used in 131 trauma patients, most commonly used to arrest persistent coagu­lopathic bleeding or oozing either from raw sur­faces or requiring additional repairs in conjunction with other operative techniques. Pneumonectomy was a deadly intervention; however, one study reported survivors when pneumonectomy was deferred [44]. The intrathoracic packing is com­monly utilized in conjunction with other opera­tive interventions such as cardiography, vein ligation, and arterial repair to manage severe chest trauma effectively. The ndings suggest that intrathoracic packing serves as a valuable

12.6). By using hemostatic resuscitation instead

Complications associated with damage con­trol can be classied as local (abscess, stula, and intestinal necrosis) or systemic complications (ARDS and MOF). They are also divided into early (missed injuries, infections, and compart­ment syndrome) and late (stula, dehiscence).

Patients with a septic abdomen have similar man­agement focuses as the damage control trauma patient; however, the sequence differs. A longer initial resuscitation phase is used in the septic abdomen. The operative goal at the initial lapa­rotomy is control of the infectious source. In gen­eral a temporary abdominal closure is used at the end of the initial laparotomy. A second resuscita­tive phase is then performed in the ICU in prepa­ration for further surgery. If control of the septic source is not done, then subsequent interventions