Trauma Hemostasis and Oxygenation Research Network position paper on the role of hypotensive resuscitation as part of remote damage control resuscitation

Thomas Woolley, Patrick Thompson, Emrys Kirkman, Richard Reed, Sylvain Ausset, Andrew Beckett, Christopher Bjerkvig, Andrew P Cap, Tim Coats, Mitchell Cohen, Marc Despasquale, Warren Dorlac, Heidi Doughty, Richard Dutton, Brian Eastridge, Elon Glassberg, Anthony Hudson, Donald Jenkins, Sean Keenan, Christophe Martinaud, Ethan Miles, Ernest Moore, Giles Nordmann, Nicolas Prat, Joseph Rappold, Michael C Reade, Paul Rees, Rory Rickard, Martin Schreiber, Stacy Shackelford, Håkon Skogran Eliassen, Jason Smith, Mike Smith, Philip Spinella, Geir Strandenes, Kevin Ward, Sarah Watts, Nathan White, Steve Williams

The Trauma Hemostasis and Oxygenation Research (THOR) Network has developed a consensus statement on the role of permissive hypotension in remote damage control resuscitation (RDCR). A summary of the evidence on permissive hypotension follows the THOR Network position on the topic. In RDCR, the burden of time in the care of the patients suffering from noncompressible hemorrhage affects outcomes. Despite the lack of published evidence, and based on clinical experience and expertise, it is the THOR Network's opinion that the increase in prehospital time leads to an increased burden of shock, which poses a greater risk to the patient than the risk of rebleeding due to slightly increased blood pressure, especially when blood products are available as part of prehospital resuscitation.The THOR Network's consensus statement is, "In a casualty with life-threatening hemorrhage, shock should be reversed as soon as possible using a blood-based HR fluid. Whole blood is preferred to blood components. As a part of this HR, the initial systolic blood pressure target should be 100 mm Hg. In RDCR, it is vital for higher echelon care providers to receive a casualty with sufficient physiologic reserve to survive definitive surgical hemostasis and aggressive resuscitation. The combined use of blood-based resuscitation and limiting systolic blood pressure is believed to be effective in promoting hemostasis and reversing shock".