The European guideline on management of major bleeding and coagulopathy following trauma

Overview

This fifth edition of the European trauma bleeding guideline was published in Critical Care (Spahn et al., 2019). Post-traumatic bleeding remains a leading cause of potentially preventable death after injury, and the guideline aims to support management of major bleeding and coagulopathy while encouraging each institution to adapt its principles to local resources.

Who developed it

The recommendations come from the pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma, founded in 2004, with representatives of six European professional societies. The group used a structured, evidence-based consensus process, and considered expert opinion and current practice where randomised trials have not been or cannot be performed.

How it is organised

The guideline follows the patient pathway in roughly the order decisions are made: initial resuscitation and prevention of further bleeding, diagnosis and monitoring of bleeding, tissue oxygenation and temperature management, rapid control of the bleeding source, initial management of bleeding and coagulopathy, further goal-directed treatment, and thromboprophylaxis. Recommendations are grouped around patient- and problem-oriented decision points rather than individual treatments.

Key themes

The edition reflects a better understanding of how trauma-induced coagulopathy develops. It supports early, individualised, goal-directed treatment, and the authors argue that the largest gains in outcome come from education and from local protocols for managing bleeding trauma patients, backed by quality management.

Practical use

Because the recommendations follow the sequence of clinical decisions from the scene of injury through the emergency department to intensive care, the guideline works well as a framework for building local major-bleeding protocols and for training the teams who deliver them.

Who it is for

Emergency physicians, trauma surgeons, anaesthesiologists, intensivists and haematologists involved in the care of severely injured patients.