title: Management of bleeding following major trauma: an updated European guideline.
abstract: BACKGROUND
  Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes.
  
  
  METHODS
  The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.
  
  
  RESULTS
  Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.
  
  
  CONCLUSIONS
  This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients.
authors.affiliation: Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, Aachen, Germany. rrossaint@ukaachen.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
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: Beverley J
authors.initials: BJ
authors.lastname: Hunt
authors.forename: Radko
authors.initials: R
authors.lastname: Komadina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nardi
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: Philip F
authors.initials: PF
authors.lastname: Stahel
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D004638:Emergency Treatment; D005060:Europe; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D006489:Hemostatic Techniques; D006801:Humans; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000628:therapy*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy