title: Management of bleeding following major trauma: a European guideline.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. donat.spahn@usz.ch
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cerny
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coats
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
authors.forename: Enrique
authors.initials: E
authors.lastname: Fernández-Mondéjar
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gordini
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel
authors.forename: Beverley J
authors.initials: BJ
authors.lastname: Hunt
authors.forename: Radko
authors.initials: R
authors.lastname: Komadina
authors.forename: Edmund
authors.initials: E
authors.lastname: Neugebauer
authors.forename: Yves
authors.initials: Y
authors.lastname: Ozier
authors.forename: Louis
authors.initials: L
authors.lastname: Riddez
authors.forename: Arthur
authors.initials: A
authors.lastname: Schultz
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders; D001802:Blood Substitutes / Q000627:therapeutic use; D001803:Blood Transfusion; D004621:Embolization, Therapeutic; D004638:Emergency Treatment; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
chemical_list: D000933:Antifibrinolytic Agents; D001802:Blood Substitutes