Publication: The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition.
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Identifiers
Date
2016-04-12
Authors
Rossaint, Rolf
Bouillon, Bertil
Cerny, Vladimir
Coats, Timothy J
Duranteau, Jacques
Fernández-Mondéjar, Enrique
Filipescu, Daniela
Hunt, Beverley J
Komadina, Radko
Nardi, Giuseppe
Advisors
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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.
Description
Journal Article. This publication has been endorsed by the European Society of Anaesthesiology (ESA), the European Society of Intensive Care Medicine (ESICM), the European Shock Society (ESS), the European Society of Trauma and Emergency Surgery (ESTES) and the European Society for Emergency Medicine (EuSEM).
MeSH Terms
Medical Subject Headings::Phenomena and Processes::Mathematical Concepts::Algorithms
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants
Medical Subject Headings::Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation Disorders
Medical Subject Headings::Psychiatry and Psychology::Behavior and Behavior Mechanisms::Psychology, Social::Group Processes::Consensus
Medical Subject Headings::Geographicals::Geographic Locations::Europe
Medical Subject Headings::Health Care::Health Care Economics and Organizations::Social Control, Formal::Jurisprudence::Expert Testimony
Medical Subject Headings::Psychiatry and Psychology::Behavior and Behavior Mechanisms::Motivation::Goals
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment::Resuscitation
Medical Subject Headings::Health Care::Health Services Administration::Organization and Administration::Safety Management
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Administration::Hospital Departments::Emergency Service, Hospital::Trauma Centers
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality Assurance, Health Care::Guidelines as Topic
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants
Medical Subject Headings::Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation Disorders
Medical Subject Headings::Psychiatry and Psychology::Behavior and Behavior Mechanisms::Psychology, Social::Group Processes::Consensus
Medical Subject Headings::Geographicals::Geographic Locations::Europe
Medical Subject Headings::Health Care::Health Care Economics and Organizations::Social Control, Formal::Jurisprudence::Expert Testimony
Medical Subject Headings::Psychiatry and Psychology::Behavior and Behavior Mechanisms::Motivation::Goals
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment::Resuscitation
Medical Subject Headings::Health Care::Health Services Administration::Organization and Administration::Safety Management
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Administration::Hospital Departments::Emergency Service, Hospital::Trauma Centers
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality Assurance, Health Care::Guidelines as Topic
DeCS Terms
CIE Terms
Keywords
Algoritmos, Anticoagulantes, Trastornos de la coagulación sanguínea, Consenso, Europa (Continente), Testimonio de experto, Metas, Hemorragia, Humanos, Resucitación, Gestión de la seguridad, Centros Traumatológicos, Guías como asunto
Citation
Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care. 2016; 20(1):100