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Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

Authors: Rolf Rossaint, Bertil Bouillon, Vladimir Cerny, Timothy J. Coats, Jacques Duranteau, Enrique Fernández-Mondéjar, Daniela Filipescu, Beverley J. Hunt, Radko Komadina, Giuseppe Nardi, Edmund A. M. Neugebauer, Yves Ozier, Louis Riddez, Arthur Schultz, Jean-Louis Vincent, Donat R. Spahn

Published in: Critical Care | Issue 1/2016

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Abstract

Background

Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution.

Methods

The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013.

Results

The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome.

Conclusions

A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.
Appendix
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Metadata
Title
The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition
Authors
Rolf Rossaint
Bertil Bouillon
Vladimir Cerny
Timothy J. Coats
Jacques Duranteau
Enrique Fernández-Mondéjar
Daniela Filipescu
Beverley J. Hunt
Radko Komadina
Giuseppe Nardi
Edmund A. M. Neugebauer
Yves Ozier
Louis Riddez
Arthur Schultz
Jean-Louis Vincent
Donat R. Spahn
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1265-x

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