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

Abstract

BackgroundSevere 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.MethodsThe 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.ResultsThe 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.ConclusionsA 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1265-x) contains supplementary material, which is available to authorized users.

Early administration of fibrinogen concentrates improves the short‐term outcomes of severe pelvic fracture patients

“…Therefore, survival of pelvic fracture patients depends on hemostasis by TAE and control of coagulopathy by early correction of impaired coagulation factor levels 21, 22, 23. Otherwise, incomplete hemostasis and persistent coagulopathy results in devastating hemorrhage and short‐term mortality, especially in the patients with severe multiple trauma 24. In this context, the results of the study are reasonable and conform with our clinical experience.…”

Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management

“…Lactate and base deficit are sensitive tests to estimate and monitor the extent of bleeding and shock [20,21].…”

Dealing with Traumatic Coagulopathy: A Long Way to Go

“…The Task Force for Advanced Bleeding Care in Trauma which comprises a multidisciplinary team of pan-European experts representing the fields of emergency medicine, surgery, anesthesiology, hematology and intensive care medicine, was founded in 2004 with aims of developing guidelines and improving strategies to treat polytraumatic patients. The original guideline for the management of bleeding trauma patient was published in Critical Care in 2007 (8), and updated in 2010 (9), 2013 (10) and 2016 (11). Over the last 10 years, clinical management has been changed from maintaining an adequate circulating volume and oxygen carrying capacity first, then dealing with coagulopathy to hemostatic resuscitation as early as possible (5).…”

“…Over the last 10 years, clinical management has been changed from maintaining an adequate circulating volume and oxygen carrying capacity first, then dealing with coagulopathy to hemostatic resuscitation as early as possible (5). In the recent publication, Rossaint and colleagues presented 39 recommendations on initial resuscitation and prevention of further bleeding, diagnosis and monitoring of bleeding, tissue oxygenation, type of fluid and temperature management, rapid control of bleeding, initial management of bleeding coagulopathy, further resuscitation and guideline implementation and quality control (11).…”

“…They recommended that monitoring and measures to support coagulation be initiated immediately upon hospital admission (Grade 1B) (11), and tranexamic acid administered as early as possible (Grade 1A). The latter has been proved to reduce the risk of death due to bleeding by 0.8% and led to a reduction in bleeding deaths by one-third, mainly through preventing exsanguination within the first 24 h (11), in accordance with that fibrinolysis is the main mechanism of ATC (1).…”