title: [Early viscoelasticity-based coagulation therapy for severely injured bleeding patients: Report of the consensus group on the consensus conference 2014 for formulation of S2k guidelines].
abstract: Although there is increasing interest in the use of a viscoelastic test procedure (ROTEM/TEG) for diagnostics and therapy guidance of severely injured and bleeding patients, currently no uniformly accepted guidelines exist for how this technology should be integrated into clinical treatment. In September 2014 an international multidisciplinary group of opinion leaders in the field of trauma-induced coagulopathy and other disciplines involved in the treatment of severely injured patients were assembled for a 2-day consensus conference in Philadelphia (USA). This panel included trauma/accident surgeons, general/abdominal surgeons, vascular surgeons, emergency/intensive care surgeons, hematologists, transfusion specialists, anesthesiologists, laboratory physicians, pathobiologists/pathophysiologists and the lay public. A total of nine questions regarding the impact of viscoelastic testing in the early treatment of trauma patients were developed prior to the conference by a panel consensus. Early use was defined as baseline viscoelastic test result thresholds obtained within the first minutes of hospital arrival, when conventional laboratory results are not yet available. The available data for each question were then reviewed in person using standardized presentations by the expert panel. A consensus summary document was then developed and reviewed by the panel in an open forum. Finally, a 2-round Delphi poll was administered to the panel of experts regarding viscoelastic thresholds for triggering the initiation of specific treatments including fibrinogen (concentrates), platelet concentrates, blood plasma products and prothrombin complex concentrates (PCC). This report summarizes the findings and recommendations of this consensus conference, which correspond to a S2k guideline according to the system of the Association of the Scientific Medical Societies in Germany (AWMF) and taking formal consensus findings including Delphi methods into consideration.
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln-Merheim, Institut für Forschung in der Operativen Medizin (IFOM), Private Universität Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Köln, Deutschland. Marc.Maegele@t-online.de.
authors.forename: M
authors.initials: M
authors.lastname: Maegele
authors.affiliation: Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California, USA.
authors.forename: K
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Departments of Surgery & Critical Care Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Kanada.
authors.forename: S
authors.initials: S
authors.lastname: Rizoli
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Center and Institute of Medical Science, University of Toronto, Toronto, Ontario, Kanada.
authors.forename: P
authors.initials: P
authors.lastname: Veigas
authors.affiliation: Department of Clinical Pathology, Sunnybrook Health Sciences Center Toronto, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Kanada.
authors.forename: J
authors.initials: J
authors.lastname: Callum
authors.affiliation: Centre for Trauma Sciences, Blizard Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Davenport
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln-Merheim, Institut für Forschung in der Operativen Medizin (IFOM), Private Universität Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Köln, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Fröhlich
authors.affiliation: Department of Laboratory Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Hess
mesh_terms: D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D001809:Blood Viscosity; D003697:Delphi Technique; D017408:Guidelines as Topic; D006470:Hemorrhage / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D019095:Point-of-Care Systems; D013916:Thrombelastography / Q000379:methods*
keywords: Blood coagulation; Hyperfibrinolysis; Mortality; Point of care technology; Transfusion