Universität zu Köln

Spahn, Donat R., Bouillon, Bertil, Cerny, Vladimir, Duranteau, Jacques, Filipescu, Daniela, Hunt, Beverley J., Komadina, Radko, Maegele, Marc, Nardi, Giuseppe, Riddez, Louis, Samama, Charles-Marc, Vincent, Jean-Louis ORCID: 0000-0001-6011-6951 and Rossaint, Rolf (2019). The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit. Care, 23. LONDON: BMC. ISSN 1364-8535

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Abstract

BackgroundSevere traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources.MethodsThe pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated.ResultsAdvances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient- or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms.ConclusionsA multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Spahn, Donat R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouillon, Bertil UNSPECIFIED UNSPECIFIED UNSPECIFIED Cerny, Vladimir UNSPECIFIED UNSPECIFIED UNSPECIFIED Duranteau, Jacques UNSPECIFIED UNSPECIFIED UNSPECIFIED Filipescu, Daniela UNSPECIFIED UNSPECIFIED UNSPECIFIED Hunt, Beverley J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Komadina, Radko UNSPECIFIED UNSPECIFIED UNSPECIFIED Maegele, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Nardi, Giuseppe UNSPECIFIED UNSPECIFIED UNSPECIFIED Riddez, Louis UNSPECIFIED UNSPECIFIED UNSPECIFIED Samama, Charles-Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Vincent, Jean-Louis UNSPECIFIED orcid.org/0000-0001-6011-6951 UNSPECIFIED Rossaint, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-153327
DOI:	10.1186/s13054-019-2347-3
Journal or Publication Title:	Crit. Care
Volume:	23
Date:	2019
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1364-8535
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language POINT-OF-CARE; FRESH-FROZEN PLASMA; PROTHROMBIN COMPLEX CONCENTRATE; ACTIVATED FACTOR-VII; RECOMBINANT-FACTOR-VIIA; DAMAGE CONTROL RESUSCITATION; RANDOMIZED-CLINICAL-TRIAL; BODY COMPUTED-TOMOGRAPHY; CRITICALLY-ILL PATIENTS; VITAMIN-K ANTAGONISTS Multiple languages Critical Care Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15332