Spahn, Donat RCerny, VladimirCoats, Timothy JDuranteau, JacquesFernández-Mondéjar, EnriqueGordini, GiovanniStahel, Philip FHunt, Beverley JKomadina, RadkoNeugebauer, EdmundOzier, YvesRiddez, LouisSchultz, ArthurVincent, Jean-LouisRossaint, Rolf2012-12-132012-12-132007-02-13Spahn DR, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Gordini G et al.Management of bleeding following major trauma: a European guideline. Crit Care. 2007;11(1):R17.1364-8535http://hdl.handle.net/10668/715Journal Article; Practice Guideline;INTRODUCTION Evidence-based recommendations can be made with respect to many aspects of the acute management of the bleeding trauma patient, which when implemented may lead to improved patient outcomes. METHODS The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing guidelines for the management of bleeding following severe injury. Recommendations were formulated using a nominal group process and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) hierarchy of evidence and were based on a systematic review of published literature. RESULTS Key recommendations include the following: The time elapsed between injury and operation should be minimised for patients in need of urgent surgical bleeding control, and patients presenting with haemorrhagic shock and an identified source of bleeding should undergo immediate surgical bleeding control unless initial resuscitation measures are successful. A damage control surgical approach is essential in the severely injured patient. Pelvic ring disruptions should be closed and stabilised, followed by appropriate angiographic embolisation or surgical bleeding control, including packing. Patients presenting with haemorrhagic shock and an unidentified source of bleeding should undergo immediate further assessment as appropriate using focused sonography, computed tomography, serum lactate, and/or base deficit measurements. This guideline also reviews appropriate physiological targets and suggested use and dosing of blood products, pharmacological agents, and coagulation factor replacement in the bleeding trauma patient. CONCLUSION A multidisciplinary approach to the management of the bleeding trauma patient will help create circumstances in which optimal care can be provided. By their very nature, these guidelines reflect the current state-of-the-art and will need to be updated and revised as important new evidence becomes available.enBlood SubstitutesTrastornos de la coagulación sanguíneaSustitutos sanguíneosTransfusión sanguíneaEmbolización terapéuticaTratamiento de urgenciaHemorragiaTécnicas hemostáticasHumanosResucitaciónChoque hemorrágicoFactores de TiempoHeridas y TraumatismosCuestionariosTrastornos SomatosensorialesEspañaSíndromeTraduccionesAntifibrinolytic AgentsMedical Subject Headings::Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation DisordersMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Blood SubstitutesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Biological Therapy::Blood TransfusionMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Hemostatic Techniques::Embolization, TherapeuticMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency TreatmentMedical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::HemorrhageMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Hemostatic TechniquesMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment::ResuscitationMedical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage::Shock, HemorrhagicMedical Subject Headings::Phenomena and Processes::Physical Phenomena::Time::Time FactorsMedical Subject Headings::Diseases::Wounds and Injuriesresearch article17298665open access10.1186/cc56861466-609XPMC2151863