title: Hemotherapy algorithm for the management of trauma-induced coagulopathy: the German and European perspective.
abstract: OBJECTIVE
  This review presents a synopsis of best current knowledge with reference to the updated German and European guidelines and recommendations on the management of severe trauma hemorrhage and trauma-induced coagulopathy as well as a viscoelastic-based treatment algorithm based upon international expert consensus to trigger the administration of hemostatic agents and blood products.
  
  
  RESULTS
  Uncontrolled hemorrhage and trauma-induced coagulopathy are the major causes for preventable death after trauma and early detection and aggressive management have been associated with improved outcomes. However, best practice to treat this newly defined entity is still under debate. In the acute phase, the clinical management usually follows the 'Damage Control Resuscitation' concept, which advocates the empiric administration of blood products in predefined and fixed ratios. As an alternative, several European but also a few US trauma centers have instituted the concept of 'Goal-directed Coagulation Therapy' based upon results obtained from early point-of-care viscoelastic testing.
  
  
  CONCLUSIONS
  Current guidelines urge for the implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome.
authors.affiliation: aDepartment for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC) bInstitute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Köln, Germany cDepartment for Anesthesiology and Intensive Care Medicine, Ospedali di Rimini e Riccione, AUSL della Romagna, Rimini, Italy dDepartment for Anesthesiology and Intensive Care Medicine, AUVA Trauma Hospital, Salzburg, Austria.
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nardi
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
mesh_terms: D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D001780:Blood Coagulation Tests / Q000295:instrumentation; D001803:Blood Transfusion / Q000379:methods / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards*; D005060:Europe; D055416:Evidence-Based Emergency Medicine / Q000379:methods*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods / Q000592:standards*; D014193:Trauma Centers / Q000592:standards / Q000639:trends; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D006490:Hemostatics