Damage Control (DC) initially referred to surgical techniques used in the operating room. This concept has now been expanded to include damage control resuscitation, which includes permissive hypotension, early empiric blood component therapy, and the prevention and treatment of hypothermia and acidosis.

DC techniques can be applied to most anatomical areas and structures, including the neck, chest, abdomen, vessels, and fractures.

DC surgery is an abbreviated procedure with the goal of rapidly controlling bleeding and contamination so that the initial procedure can be terminated, decreasing surgical stress and allowing a focus on resuscitation. This should be considered in patients with progressive physiologic exhaustion, who are at risk of irreversible shock and death. After physiologic resuscitation, the patient is returned to the operating room for definitive reconstruction and eventual definitive closure of the involved cavity.

The standard indications for DC include:

• Patients in “extremis,” with coagulopathy, hypothermia <35°C, acidosis (base deficit >15 mmol/L), elevated lactate, prolonged hypotension on pressors.

• Bleeding from difficult to control injuries (complex liver injuries, retroperitoneum, mediastinum, neck, and complex vascular).

• In suboptimal environments, such as the rural or battlefield setting or with inexperienced surgeons without the adequate skillset to definitively manage the injury.

For maximum benefit, damage control should be considered early, before the patient reaches the “in extremis” condition! Consider the nature of the injury, the physiologic condition of the patient, comorbid conditions, the available resources, and the experience of the surgeon. The timing of DC surgery is critical in determining the outcome.