Integrated Resuscitation Strategies in Orthopedic Trauma: A Systematic Review of Outcomes of Cardiopulmonary Resuscitation (CPR), Hemorrhage Control, and Damage Control

Abstract

Orthopedic trauma is a major cause of global morbidity and mortality, often resulting from high-energy mechanisms such as road traffic accidents, falls, and interpersonal violence. Early deaths are frequently due to hemorrhage, coagulopathy, and physiologic instability. This systematic review, following PRISMA 2020 guidelines, included six studies with a total of 28,549 patients. The majority came from the CRASH-2 randomized controlled trial (20,211 bleeding trauma patients, many with orthopedic injuries). The remaining five studies together contributed 8,338 patients to evaluate integrated resuscitation strategies: trauma-specific CPR, hemorrhage control (tourniquets, pelvic stabilization, massive transfusion protocols, tranexamic acid, resuscitative endovascular balloon occlusion of the aorta (REBOA)/embolization), and fracture fixation timing (damage control orthopedics vs early appropriate care/early total care). Evidence indicates that early hemorrhage control, physiologically guided resuscitation, and timely operative intervention improve survival, reduce complications, and optimize functional outcomes. Standardized, protocol-driven approaches and resource-sensitive adaptations remain essential for effective orthopedic trauma care.