Overall, injuries are the third leading cause of death in the United States, but they affect the younger and most productive segment of our society disproportionately. According to the National Center for Health Statistics, injuries are the number one cause of death and disability under age 44, and more Americans between the ages of 1–34 years are killed by injuries than by all other diseases combined1. The financial impact of injuries is staggering- 50 million injuries that required medical treatment in 2000 will ultimately cost the US society $406 billion, including $80.2 billion in medical care costs and $326 billion in lost productivity2.
Analysis of epidemiological data from large trauma centers reveals consistent patterns of death 3–7. Up to half of the deaths occur prior to arrival in a hospital as a result of massive blood loss or central nervous system (CNS) damage. Compared to severe CNS damage, death resulting from bleeding is potentially preventable, and life saving efforts focus on early control of bleeding and adequate resuscitation. Unfortunately, conventional resuscitation methods often exacerbate the underlying cellular injury8. Of the patients that are transported to the hospital, the majority (70–80%) dies within the first 24–48 hours, with a much smaller percentage (<10%) succumbing to late death as a result of sepsis and organ failure. As hemorrhage-related deaths primarily occur in the first six hours after injury5, early delivery of high quality care is of critical importance. Despite hemorrhage being a common problem, the optimal resuscitative strategy remains controversial, with vigorous debates about the type of fluid, volume, rate, route of administration, and end points of resuscitation. This review highlights recent advances in resuscitation strategies as our understanding of the body’s response to hemorrhage and resuscitation has evolved.