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Title: Management of bleeding following major trauma: A European guideline
Authors: Spahn, D. R.
Cerny, V.
Coats, T. J.
Duranteau, J.
Fernandez-Mondejar, E.
Gordini, G.
Stahel, P. F.
Hunt, B. J.
Komadina, R.
Neugebauer, E.
Ozier, Y.
Riddez, L.
Schultz, A.
Vincent, J-L.
Rossaint, R.
Task Force for Advanced Bleeding Care in Trauma
First Published: 13-Feb-2007
Publisher: BioMed Central
Citation: Critical Care, 2007, 11 : R17
Abstract: INTRODUCTION: Evidence-based recommendations can be made with respect to many aspects of the acute management of the bleeding trauma patient, which when implemented may lead to improved patient outcomes. METHODS: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing guidelines for the management of bleeding following severe injury. Recommendations were formulated using a nominal group process and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) hierarchy of evidence and were based on a systematic review of published literature. RESULTS: Key recommendations include the following: The time elapsed between injury and operation should be minimised for patients in need of urgent surgical bleeding control, and patients presenting with haemorrhagic shock and an identified source of bleeding should undergo immediate surgical bleeding control unless initial resuscitation measures are successful. A damage control surgical approach is essential in the severely injured patient. Pelvic ring disruptions should be closed and stabilised, followed by appropriate angiographic embolisation or surgical bleeding control, including packing. Patients presenting with haemorrhagic shock and an unidentified source of bleeding should undergo immediate further assessment as appropriate using focused sonography, computed tomography, serum lactate, and/or base deficit measurements. This guideline also reviews appropriate physiological targets and suggested use and dosing of blood products, pharmacological agents, and coagulation factor replacement in the bleeding trauma patient. CONCLUSION: A multidisciplinary approach to the management of the bleeding trauma patient will help create circumstances in which optimal care can be provided. By their very nature, these guidelines reflect the current state-of-the-art and will need to be updated and revised as important new evidence becomes available.
DOI Link: 10.1186/cc5686
ISSN: 1364-8535
eISSN: 1466-609X
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2007 Spahn et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description: A correction for this article has been published in Critical Care 2007, 11:414
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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