Impact of Early Damage Control Surgery, Anesthesia, and Resuscitation Strategies on Outcomes of Polytrauma Patients from Emergency Department to ICU: A Systematic Review

Abstract

Background: The optimal application of early damage control surgery (DCS) combined with damage control resuscitation (DCR) from the emergency department (ED) in polytrauma remains debated, with conflicting evidence regarding its impact on mortality and intensive care unit (ICU) outcomes. This review seeks to systematically review the impact of early DCS combined with anesthesia and resuscitation strategies, initiated from the ED, on mortality and ICU-related outcomes in adult polytrauma patients by the Injury Severity Score (ISS). Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials [CENTRAL], Scopus) were searched from 2013 to 2024 for studies comparing early DCS/DCR to standard/delayed care. Two reviewers independently screened studies, extracted data, and assessed risk of bias using design-specific tools, such as the revised Cochrane Risk of Bias tool (RoB 2) and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Results: Eleven studies were included: 2 randomized controlled trials (RCTs) and 9 observational/registry studies. Evidence was heterogeneous. Early DCS/DCR showed significant mortality benefit in patients with profound physiological derangement (e.g., hemorrhagic shock, acidosis), with some studies reporting reductions in early mortality from 33% to 16%. Conversely, several studies, including a large RCT on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), found no benefit or increased mortality and morbidity (longer ICU stay, higher sepsis rates) when damage control strategies were applied to less compromised patients or without clear physiological triggers. Conclusion: The efficacy of early DCS/DCR is not universal but is contingent upon strict physiological selection. A targeted, physiology-driven approach improves survival in severely deranged polytrauma patients, while routine or liberal application may cause harm. Future practice and research should focus on refining real-time physiological triggers and integrating immunomodulatory strategies post-DCS to mitigate complications.