The Solstrand Remote Damage Control Resuscitation Symposium

T his year the Traumatic Hemostasis and Oxygenation Research (THOR) Network had its second annual conference from June 19 to 21 at the Solstrand Hotel, near Bergen, Norway. The first symposium was held on June 14, 2011, and was a 1-day symposium that focused on prehospital use of fresh whole blood. This year we held a 3-day symposium and broadened the scope to include a wider spectrum of treatment and monitoring options for remote damage control resuscitation (RDCR). As hemorrhage remains a major cause of potentially preventable deaths in both civilian and military combat trauma patients, it was essential to have both perspectives presented at the symposium. The RDCR Symposium was sponsored and organized by the Norwegian Naval Special Operation Commando together with the Norwegian Air Ambulance Foundation. The US Office of Naval Research and the US Department of Defense Combat Casualty Care Research Program also provided support for the Symposium. While highly controversial, recent experience with DCR concepts have led many trauma centers to incorporate them into their standard practice to include early administration of high ratio plasma to red cell transfusion with limited use of crystalloids and colloids. Exporting DCR concepts to the prehospital arena is the essence of RDCR. RDCR is still not well defined though. The main question remains: what defines “remote”? Is it all prehospital care or only when evacuation to surgical care is prolonged? If “remote” is defined as “a prolonged evacuation,” how much time is required prior to hospital admission to constitute “remote”? The main goal of prehospital care for patients with traumatic hemorrhagic shock should be identical to intrahospital care. This is the reduction of mortality and morbidity from hemorrhage by the rapid prevention and treatment of traumatic coagulopathy and shock without exacerbating it. Applying these as prehospital goals has the potential to improve outcomes for those requiring intrahospital DCR therapy. The main barrier to applying RDCR concepts in the prehospital setting has been the availability of blood products and clear evidence of when they are indicated. Advancements in this area of prehospital care have significant potential to improve outcomes for patients with life-threatening hemorrhagic injuries. Research exploring the etiology of shock and coagulopathy for patients with traumatic injury is essential to determining the prehospital indications for blood products. To facilitate the basic science required to be performed there needs to be consistency in the terms used to define phases of traumatic shock and coagulopathy based upon pathophysiology. There currently is not uniformity on terminology, and this should be a primary goal for all trauma-related societies and research networks to establish together. Another important goal is the development of a common data collection platform throughout the world that incorporates both preand intrahospital data, that includes adequate physiologic and laboratory data, and meaningful shortand long-term outcomes. The appropriate design of translational research in this area is dependent upon highly accurate epidemiologic and outcomes data. We cannot move forward substantially without robust information to guide us.