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

Abstract

Background

Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management.

Methods

The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation.

Results

This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury.

Conclusion

A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-023-04327-7.

Key messages

• Immediate detection and management of traumatic coagulopathy improves outcomes of severely injured patients.

• This guideline follows management of the severe trauma patient in chronological order, with a focus on prevention of possible exsanguination.

• These structured recommendations support measures that prioritise the optimisation of resources for the benefit of bleeding control based on scientific evidence.

• Empirical management should not be implemented unless no method of monitoring bleeding and coagulation is available.

• Optimal organisation of the resuscitation team for the bleeding trauma patient includes implementation of these guidelines.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-023-04327-7.