Global casualty care in operation area (cardiopulmonary resuscitation and damage control surgery)

Urgent surgery should not be performed preferably for at least 72 hours after a cardiac arrest to minimize the risk for additional perfusion-related organ injury. However, in peculiar circumstances, especially in a military setting, emergency surgery may be necessary in selected patients to save health and life. A previously healthy 34-year-old soldier developed multiple splinter injuries and mangled injury to his right arm after a missile attack. Due to heavy shelling and enemy fire, he bled profusely and could not be immediately evacuated to the medical aid post. After reaching the first-aid post, he was navigated through various medical echelons before reaching our center (Level III) where he was resuscitated and limb-salvage surgery was done. En route to the hospital, he suffered a cardiac arrest, was resuscitated, and had the second arrest on arrival. He was revived within 3 minutes and rushed to the operation theatre, where damage control surgery was done, including a brachial artery anastomosis. After the initial surgery, he was air-evacuated to the nearest tertiary center, where he was further managed by the vascular surgeon and cardiologist and made a full recovery. Immediate hemostasis of culprit injury is mandatory to make fluid resuscitation effective. Administering effective CPR, volume replenishment using crystalloids and whole blood, balanced anesthesia, damage control surgery, and teamwork can save patients’ limbs and lives.