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Critical Care
Published in: Critical Care 1/2007

Open Access 01-02-2007 | Research

Management of bleeding following major trauma: a European guideline

Authors: Donat R Spahn, Vladimir Cerny, Timothy J Coats, Jacques Duranteau, Enrique Fernández-Mondéjar, Giovanni Gordini, Philip F Stahel, Beverley J Hunt, Radko Komadina, Edmund Neugebauer, Yves Ozier, Louis Riddez, Arthur Schultz, Jean-Louis Vincent, Rolf Rossaint

Published in: Critical Care | Issue 1/2007

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Abstract

Introduction

Evidence-based recommendations can be made with respect to many aspects of the acute management of the bleeding trauma patient, which when implemented may lead to improved patient outcomes.

Methods

The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing guidelines for the management of bleeding following severe injury. Recommendations were formulated using a nominal group process and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) hierarchy of evidence and were based on a systematic review of published literature.

Results

Key recommendations include the following: The time elapsed between injury and operation should be minimised for patients in need of urgent surgical bleeding control, and patients presenting with haemorrhagic shock and an identified source of bleeding should undergo immediate surgical bleeding control unless initial resuscitation measures are successful. A damage control surgical approach is essential in the severely injured patient. Pelvic ring disruptions should be closed and stabilised, followed by appropriate angiographic embolisation or surgical bleeding control, including packing. Patients presenting with haemorrhagic shock and an unidentified source of bleeding should undergo immediate further assessment as appropriate using focused sonography, computed tomography, serum lactate, and/or base deficit measurements. This guideline also reviews appropriate physiological targets and suggested use and dosing of blood products, pharmacological agents, and coagulation factor replacement in the bleeding trauma patient.

Conclusion

A multidisciplinary approach to the management of the bleeding trauma patient will help create circumstances in which optimal care can be provided. By their very nature, these guidelines reflect the current state-of-the-art and will need to be updated and revised as important new evidence becomes available.
Appendix
Available only for authorised users
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Metadata
Title
Management of bleeding following major trauma: a European guideline
Authors
Donat R Spahn
Vladimir Cerny
Timothy J Coats
Jacques Duranteau
Enrique Fernández-Mondéjar
Giovanni Gordini
Philip F Stahel
Beverley J Hunt
Radko Komadina
Edmund Neugebauer
Yves Ozier
Louis Riddez
Arthur Schultz
Jean-Louis Vincent
Rolf Rossaint
Publication date
01-02-2007
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2007
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5686

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