Management of bleeding following major trauma: an updated European guideline.
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.
Rossaint
Rolf
R
Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, Aachen, Germany. rrossaint@ukaachen.de
Bouillon
Bertil
B
Cerny
Vladimir
V
Coats
Timothy J
TJ
Duranteau
Jacques
J
Fernández-Mondéjar
Enrique
E
Hunt
Beverley J
BJ
Komadina
Radko
R
Nardi
Giuseppe
G
Neugebauer
Edmund
E
Ozier
Yves
Y
Riddez
Louis
L
Schultz
Arthur
A
Stahel
Philip F
PF
Vincent
Jean-Louis
JL
Spahn
Donat R
DR
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