Exsanguination Shock: The Next Frontier in Prevention of Battlefield Mortality

Heretofore, those wounded in combat who arrived at a deployed medical treatment facility with signs of life and subsequently died have been designated as having died of wounds, with the vast majority classified as dying due to hemorrhage from nondescript hemorrhagic shock.1 4 In the future, the development and use of new technology may offer the greatest potential for decreasing mortality among these patients in the deployed setting. A subset of patients who pose a particularly vexing challenge to combat medics, emergency physicians, and surgeons are those who are severely hypotensive andor pulseless on arrival, but who are able to be resuscitated to the point of clinical hemostasis and seemingly viable physiology only to eventually regress to cardiovascular collapse and death. These patients for all intent and purposes meet the definition of exsanguination, 5,6 and to improve survival, their condition must be more fully described and better understood. The objective of this commentary is to re-introduce the term exsanguination shock and to provide a rudimentary characterization of this condition in combat casualty care.