Management of bleeding following major trauma: an updated European guideline

TLDR

Evidence‑based recommendations are needed to guide acute bleeding management in trauma patients, potentially improving outcomes. The Task Force for Advanced Bleeding Care in Trauma was formed to develop and update a guideline for managing bleeding after severe injury. Guideline recommendations were generated through a nominal group process, GRADE evaluation, and systematic literature review, incorporating recent evidence and practice changes. The updated guideline introduces new recommendations on coagulation support, monitoring, local haemostatic measures, tourniquets, calcium, and desmopressin, and reevaluates prior recommendations to provide an evidence‑based multidisciplinary approach.

Abstract

Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients.