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

Abstract

Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

Four-Factor Prothrombin Complex Concentrate for Patients With Trauma—Reply

“…With regard to the amount of fluid resuscitation, both groups received low-volume fluid resuscitation according to European guidelines, without any difference between the 2 groups. Any effect on the pathophysiology of thromboembolic events is unlikely.…”

Mobile blood depots in ground ambulances in compliance with French legislation: A feasibility study

“…6 During the waiting period, the ALS team continued to manage the patient, including venous line placements, hemostatic resuscitation, hypothermia prevention, etc. 19 Transfusion can be started while driving, following the military enroute care strategy. 20 Our procedure seems cumbersome, since prehospital transfusion programs aboard land or air ambulances have existed in many countries for several years.…”

Combined Platelet and Red Blood Cell Recovery during On-pump Cardiac Surgery Using same™ by i-SEP Autotransfusion Device: A First-in-human Noncomparative Study (i-TRANSEP Study)

“…This result is consistent with massive transfusion protocols using plasma, platelets, and red blood cells in a 1:1:1 to 1:1:2 ratio. 35 By offering the opportunity to reinfuse to the patients their own platelets in addition to their red blood cells, this new device might significantly improve perioperative hemostasis. This hypothesis remains valid during cardiac surgery, as there is limited evidence linking cardiopulmonary bypass–induced platelet dysfunction, which is poorly characterized, to increased bleeding risk.…”