Rossaint, RolfBouillon, BertilCerny, VladimirCoats, Timothy JDuranteau, JacquesFernández-Mondéjar, EnriqueFilipescu, DanielaHunt, Beverley JKomadina, RadkoNardi, GiuseppeNeugebauer, Edmund A MOzier, YvesRiddez, LouisSchultz, ArthurVincent, Jean-LouisSpahn, Donat R2016-05-302016-05-302016-04-12Rossaint 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):1001364-8535http://hdl.handle.net/10668/2202Journal 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).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.enAlgoritmosAnticoagulantesTrastornos de la coagulación sanguíneaConsensoEuropa (Continente)Testimonio de expertoMetasHemorragiaHumanosResucitaciónGestión de la seguridadCentros TraumatológicosGuías como asuntoMedical Subject Headings::Phenomena and Processes::Mathematical Concepts::AlgorithmsMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::AnticoagulantsMedical Subject Headings::Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation DisordersMedical Subject Headings::Psychiatry and Psychology::Behavior and Behavior Mechanisms::Psychology, Social::Group Processes::ConsensusMedical Subject Headings::Geographicals::Geographic Locations::EuropeMedical Subject Headings::Health Care::Health Care Economics and Organizations::Social Control, Formal::Jurisprudence::Expert TestimonyMedical Subject Headings::Psychiatry and Psychology::Behavior and Behavior Mechanisms::Motivation::GoalsMedical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::HemorrhageMedical 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::Health Care::Health Services Administration::Organization and Administration::Safety ManagementMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Administration::Hospital Departments::Emergency Service, Hospital::Trauma CentersMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality Assurance, Health Care::Guidelines as Topicresearch article27072503open access10.1186/s13054-016-1265-x1466-609XPMC4828865