„Hämoglobinorientierter und gerinnungsfaktorbasierter Algorithmus“

Hilbert-Carius, Peter; Hofmann, Gunther O.; Stuttmann, R.

doi:10.1007/s00101-015-0093-8

Cited by 10 publications

(3 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is increasing interest in the use of goal-directed strategies guided by either POC VEM [543–549] or CCAs [522, 550] to augment DCR during the acute care of bleeding trauma patients [551–554]. A recent survey among surgeons and anaesthesiologists in Germany revealed that 90% used CCA to guide decision-making in the diagnosis and treatment of bleeding trauma patients, whereas 56% reported that they also used extended VEM such as ROTEM® or TEG® [555], and this predominantly in advanced trauma centres [556].…”

Section: Resultsmentioning

confidence: 99%

“…In the intention-to-treat analysis, all-cause 28-day mortality was 5/35 (14.3%) in the laboratory-result-guided transfusion group versus 13/40 (32.5%) in the group that was treated according to the fixed-ratio 1:1:1 protocol [RR 2.27 (95% CI 0.98–9.63)]. The introduction of a novel standard operating procedure (SOP) using a Hb/CCA-oriented and coagulation-factor-based algorithm for the early correction of trauma-induced coagulopathy in patients requiring a massive transfusion was retrospectively assessed using a pre- and post-implementation approach at a single centre in Germany [550]. The main objective was the effect on transfusion requirements and the standardised mortality ratio (SMR), which is the ratio of observed deaths to expected/predicted deaths.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2019

View full text Add to dashboard Cite

Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied 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 reexamined and revised based on scientific evidence that has emerged since the previous edition 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. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In addition, there is no universal recommendation backed by large evidence how to include specific factor concentrates (e.g., prothrombin complex concentrates [PCC]) or single coagulation factors products (fibrinogen [FI], FVII), within these algorithms. Keeping that in mind, multiple but mostly retrospective data indicate an overall benefit of goal-directed resuscitation and transfusion strategies using global coagulation testing approaches guided either via VHA 34 35 or CCT monitoring 36 37 over DCR in bleeding trauma patients. Interestingly, these studies suggest that (besides all limitations of CCT-monitored strategies like longer turnaround times compared with bedside VHA and missing information on clot formation dynamics and lysis) they might be superior to the use of fixed-ratio methods.…”

Section: Scenario 1: Coagulopathy Following Major Trauma: Goal-direct...mentioning

confidence: 99%

Global Coagulation Testing in Acute Care Medicine: Back to Bedside?

et al. 2022

View full text Add to dashboard Cite

Objectives Detailed and decisive information about the patients' coagulation status is important in various emergency situations. Conventional global coagulation testing strategies are often used to provide a quick overview, but several limitations particularly in the trauma setting are well described. With the introduction of direct oral anticoagulations (DOACs), a milestone for several disease entities resulting in overall improved outcomes could be reached, but at the same time providing new diagnostic challenges for the emergency situation. Design As an alternative to conventional coagulation tests, there is increasing clinical and scientific interest in the use of early whole blood strategies to provide goal-directed coagulation therapies (GDCT) and hemostatic control in critically ill patients. Viscoelastic hemostatic assays (VHAs) were therefore introduced to several clinical applications and may provide as a bedside point-of-care method for faster information on the underlying hemostatic deficiency. Conclusion The use of VHA-based algorithms to guide hemostatic control in emergency situations now found its way to several international guidelines for patients at risk of bleeding. With this qualitative review, we would like to focus on VHA-based GDCT and review the current evidence for its use, advantages, and challenges in the two different clinical scenarios of trauma and intracerebral bleeding/stroke management.

show abstract