Universität zu Köln

Lier, H., Bernhard, M. and Hilbert-Carius, P. (2018). The Coagulation system in the German S3 guideline on treatment of polytrauma and severely injured patients 2016. Update on the latest concepts for sufficient hemostasis. Notfall Rettungsmed., 21 (1). S. 14 - 22. NEW YORK: SPRINGER. ISSN 1436-0578

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Abstract

Traumatic brain injury and massive bleeding are the most frequent causes of death in severely injured patients. Uncontrolled hemorrhage is still a major cause of preventable death after trauma. The current German S3 trauma guideline on the treatment of polytrauma and severely injured patients emphasize the importance of early bleeding control in various areas. Besides uncontrolled hemorrhage, subsequent trauma-induced coagulopathy (TIC) is a second frequent problem after trauma; therefore, the current guideline addresses TIC in a separate and dedicated chapter. The key factors in management of TIC are early detection and aggressive therapy. Apart from standard coagulation tests and parameters indicating shock, viscoelastic tests are of increasing interest in the diagnostics of TIC. Trauma centers are urged to establish massive transfusion and coagulation protocols, which are individually adapted to the structure of the hospital. For treatment an optimization of the preconditions of coagulation, such as normothermia, normovolemia, normocalcemia and prevention of acidosis must be considered, even if sometimes hard to establish. Besides damage control resuscitation, two therapeutic approaches are possible: a ratio-driven and a coagulation factor-based regimen for treatment of TIC. Independent of the preferred concept, the early use of tranexamic acid should be taken into consideration for bleeding trauma patients. The present article summarizes the coagulation chapter of the current German guideline and gives a brief overview of current publications on this topic.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lier, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bernhard, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hilbert-Carius, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-197768
DOI:	10.1007/s10049-017-0361-z
Journal or Publication Title:	Notfall Rettungsmed.
Volume:	21
Number:	1
Page Range:	S. 14 - 22
Date:	2018
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1436-0578
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RANDOMIZED-CLINICAL-TRIAL; TRAUMA PATIENTS; PLATELET-FUNCTION; COAGULOPATHY; TRANSFUSION; RESUSCITATION; MORTALITY; PLASMA; MANAGEMENT; THERAPY Multiple languages Emergency Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19776