Management of bleeding following major trauma: a European guideline

Spahn, Donat R.; Černý, Vladimír; Coats, Timothy J; Duranteau, Jacques; Fernández-Mondéjar, E.; Gordini, Giovanni; Stahel, Philip F.; Hunt, Beverley J.; Komadina, Radko; Neugebauer, Edmund; Ozier, Yves; Riddez, Louis; Schultz, A.; Vincent, Jean‐Louis; Rossaint, Rolf

doi:10.1186/cc5781

Cited by 96 publications

(131 citation statements)

References 1 publication

(1 reference statement)

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“…[24] Many studies have reported an increased mortality in intubated patients. [25][26][27] The mortality rates of patients in our study who arrived intubated, hypotensive, and tachycardic were consistent with the literature findings.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Mortality In Falls From Height

İçer

Güloğlu

Orak

et al. 2013

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Mortality In Falls From Height

İçer

Güloğlu

Orak

et al. 2013

Ulus Travma Acil Cerrahi Derg

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“…An international initiative, the Multidisciplinary European Task Force for Advanced Bleeding Care, developed comprehensive guidelines on multiples aspects of the management of bleeding following severe injury, including recommendations on the use of CRYO and fibrinogen concentrates (Spahn et al, 2007). According to the grading system utilized in these guidelines (Guyatt et al, 2006), the recommendations on CRYO use (grade 1 C) were derived from observational studies and case series, and graded as being low-quality evidence but where the benefits clearly outweighed the risks, thus being classified as strong recommendations.…”

Section: Management Of Bleeding After Major Trauma: a European Guidelmentioning

confidence: 99%

Cryoprecipitate transfusion: assessing appropriateness and dosing in trauma

Nascimento¹,

Rizoli²,

Rubenfeld³

et al. 2011

Transfusion Medicine

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Cryoprecipitate is commonly used outside guidelines. In trauma, the appropriate cryoprecipitate dose and its impact on plasma fibrinogen levels are unclear.This retrospective study aims to evaluate: (1) the appropriateness of cryoprecipitate transfusion in trauma; and (2) the plasma fibrinogen response to cryoprecipitate transfusion during massive transfusion in trauma.Fibrinogen levels of < 1.0 g/L within 2 and 6 hours of cryoprecipitate transfusion were used for assessing appropriateness. Out of 394 events, 238 (60%) and 259 (66%) were considered appropriate using 2 and 6 hour criteria, respectively. A dose of 8.7 (±1.7) units caused a mean increase in fibrinogen levels of 0.55 (±0.24) g/L, or 0.06g/L per unit.In our hospital, where transfusion guidelines and policies for rapid blood product and laboratory turnaround times exist, it is possible to achieve high rates of appropriateness for cryoprecipitate transfusion in trauma. The current recommended dose causes a modest increase in fibrinogen levels.iii

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“…[54][55][56] It is still unclear which type of fluid should be employed in the initial treatment of the bleeding trauma patient. 19 Although several meta-analyses have shown an increased risk of death in patients treated with colloids compared with patients treated with crystalloids [57][58][59][60][61] and three of these studies showed that the effect was particularly significant in a trauma subgroup, 57,59,60 a more recent meta-analysis showed no difference in mortality between colloids and crystalloids. 62 The SAFE (Saline vs. Albumin Fluid Evaluation) study compared 4% albumin with 0.9% sodium chloride in a large number of ICU patients and showed that albumin administration was not associated with worse outcomes; however, there was a trend toward higher mortality in the trauma subgroup that received albumin.…”

Section: Dilutionmentioning

confidence: 99%

New insights into acute coagulopathy in trauma patients

Ganter

Pittet

2010

Best Practice & Research Clinical Anaesthesiology

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Abnormal coagulation parameters can be found in 25% of trauma patients with major injuries. Furthermore, trauma patients presenting with coagulopathy on admission have worse clinical outcome. Tissue trauma and systemic hypoperfusion appear to be the primary factors responsible for the development of acute traumatic coagulopathy immediately after injury. As a result of overt activation of the protein C pathway, the acute traumatic coagulopathy is characterised by coagulopathy in conjunction with hyperfibrinolysis. This coagulopathy can then be exacerbated by subsequent physiologic and physical derangements such as consumption of coagulation factors, haemodilution, hypothermia, acidemia and inflammation, all factors being associated with ongoing haemorrhage and inadequate resuscitation or transfusion therapies. Knowledge of the different mechanisms involved in the pathogenesis of acute traumatic coagulopathy is essential for successful management of bleeding trauma patients. Therefore, early evidence suggests that treatment directed at aggressive and targeted haemostatic resuscitation can lead to reductions in mortality of severely injured patients. ABSTRACTAbnormal coagulation parameters can be found in 25% of trauma patients with major injuries. Furthermore, trauma patients presenting with coagulopathy on admission have worse clinical outcome. Tissue trauma and systemic hypoperfusion appear to be the primary factors responsible for the development of acute traumatic coagulopathy immediately after injury. As a result of overt activation of the protein C pathway, the acute traumatic coagulopathy is characterized by coagulopathy in conjunction with hyperfibrinolysis. This coagulopathy can then be exacerbated by subsequent physiologic and physical derangements like consumption of coagulation factors, hemodilution, hypothermia, acidemia, and inflammation; all factors being associated with ongoing hemorrhage and inadequate resuscitation or transfusion therapies. Knowledge of the different mechanisms involved in the pathogenesis of acute traumatic coagulopathy is essential for successful management of bleeding trauma patients. Therefore, early evidence suggests that treatment directed at aggressive and targeted hemostatic resuscitation can lead to reductions in mortality of severely injured patients.

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Management of bleeding following major trauma: a European guideline

Cited by 96 publications

References 1 publication

Factors Affecting Mortality In Falls From Height

Factors Affecting Mortality In Falls From Height

Cryoprecipitate transfusion: assessing appropriateness and dosing in trauma

New insights into acute coagulopathy in trauma patients

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