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

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: AUTHORS’ INFORMATION: RR serves as chair of the Advanced Bleeding Care in Trauma (ABC-T) European Medical Education Initiative. DRS serves as co-chair of the ABC-T European Medical Education Initiative. BB is a member of the ABC-T European Medical Education Initiative faculty. VC is a member of the ABC-T European Medical Education Initiative faculty. JD represented the European Society of Intensive Care Medicine (ESICM) on the ABC-T Task Force. DF represented the European Society of Anaesthesiology (ESA) on the ABC-T Task Force. MM represented the European Shock Society (ESS) on the ABC-T Task Force. GN is a member of the ABC-T European Medical Education Initiative faculty. BJH is a member of the ABC-T European Medical Education Initiative faculty. RK represented the European Society of Trauma and Emergency Surgery (ESTES) on the ABC-T Task Force. LR represented the European Society for Emergency Medicine (EuSEM) on the ABC-T Task Force. CMS represented the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) on the ABC-T Task Force. JLV is a member of the ABC-T European Medical Education Initiative faculty. ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Not applicable. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: In the past 5 years, DRS’s academic department has received grant support from the Swiss National Science Foundation, Berne, Switzerland, the Ministry of Health (Gesundheitsdirektion) of the Canton of Zurich, Switzerland for Highly Specialized Medicine, the Swiss Society of Anesthesiology and Reanimation (SGAR), Berne, Switzerland, the Swiss Foundation for Anesthesia Research, Zurich, Switzerland, CSL Behring, Berne, Switzerland, Vifor SA, Villars-sur-Glâne, Switzerland. DRS is co-chair of the ABC-Trauma Faculty, sponsored by unrestricted educational grants from Novo Nordisk Health Care AG, Zurich, Switzerland, CSL Behring GmbH, Marburg, Germany, LFB Biomédicaments, Courtaboeuf Cedex, France and Octapharma AG, Lachen, Switzerland. DRS received honoraria or travel support for consulting or lecturing from: Danube University of Krems, Austria, US Department of Defense, Washington, USA, European Society of Anesthesiology, Brussels, BE, Korea, Korean Society for Patient Blood Management, Seoul, Korea, Korean Society of Anesthesiologists, Seoul, Baxter AG, Volketswil, Switzerland, Baxter S.p.A., Roma, Italy, Bayer AG, Zürich, Switzerland, Bayer Pharma AG, Berlin, Germany, B. Braun Melsungen AG, Melsungen, Germany, Boehringer Ingelheim GmbH, Basel, Switzerland, Bristol-Myers-Squibb, Rueil-Malmaison Cedex, France and Baar, Switzerland, CSL Behring GmbH, Hattersheim am Main, Germany and Berne, Switzerland, Celgene International II Sàrl, Couvet, Switzerland, Curacyte AG, Munich, Germany, Daiichi Sankyo AG, Thalwil, Switzerland, GlaxoSmithKline GmbH & Co. KG, Hamburg, Germany, Haemonetics, Braintree, MA, USA, Instrumentation Laboratory (Werfen), Bedford, MA, USA, LFB Biomédicaments, Courtaboeuf Cedex, France, Merck Sharp & Dohme, Kenilworth, New Jersey, USA, Octapharma AG, Lachen, Switzerland, Organon AG, Pfäffikon/SZ, Switzerland, PAION Deutschland GmbH, Aachen, Germany, Pharmacosmos A/S, Holbaek, Denmark, Photonics Healthcare B.V., Utrecht, Netherlands, Roche Diagnostics International Ltd., Reinach, Switzerland, Roche Pharma AG, Reinach, Switzerland, Sarstedt AG & Co., Sevelen, Switzerland and Nümbrecht, Germany Schering-Plough International, Inc., Kenilworth, New Jersey, USA, Tem International GmbH, Munich, Germany, Verum Diagnostica GmbH, Munich, Germany, Vifor Pharma, Munich, Germany, Vienna, Austria and Villars-sur-Glâne, Switzerland, Vifor (International) AG, St. Gallen. BB has no competing interests to declare. In the past 5 years, VC has received honoraria for consulting or lecturing from CSL Behring, AbbVie, BBraun, Bard. VC reports research grant funding from the Czech Health Research Council, Czech Republic, and the Charles University Faculty of Medicine in Hradec Kralove, Czech Republic. VC has received institutional support from the Charles University Faculty of Medicine in Hradec Kralove, Czech Republic, the University Hospital Hradec Kralove, Czech Republic and Masaryk Hospital Usti nad Labem, Czech Republic. In the past 5 years, JD has received honoraria for lecturing from LFB Biomédicaments. In the past 5 years, DF has received honoraria for lecturing from the following companies and organisations: Romanian Society of Cardiology, MedLife Health System and Danube University of Krems, Austria. DF has received institutional support from Vifor Pharma, Siramed SRL and Synttergy Consult SRL. In the past 5 years, BJH has received research grant funding from CSL Behring. In the past 5 years, RK has received honoraria for lecturing from CSL Behring. In the past 5 years, MM has received honoraria for consulting or lecturing from Astra Zeneca, Bayer, Biotest, CSL Behring, IL Werfen/TEM International, LFB Biomedicaments France and has received research grant funding from CSL Behring. In the past 5 years, GN has received honoraria for lecturing from CSL Behring. LR has no competing interests to declare. In the past 5 years, CMS has received honoraria for consulting or lecturing from Aspen, Daiichi-Sankyo, Medtronic, Roche, BMS, Pfizer, Bayer, Stago, Siemens, Octapharma, LFB Biomédicaments and has received research grant funding from Haemonetics. JLV has no competing interests to declare. In the past 5 years, RR has received honoraria for consulting or lecturing from CSL Behring, Boehringer Ingelheim and Fresenius. In fields related to this work RR or his co-workers received research grant funding from DFG, Bayer, Biotest, Boehringer Ingelheim, CSL Behring, Novo Nordisk and Nycomed. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 5. Injury. 2019 Oct;50(10):1656-1670. doi: 10.1016/j.injury.2019.09.021. Epub 2019 Sep 13. Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020. Pape HC(1), Halvachizadeh S(2), Leenen L(3), Velmahos GD(4), Buckley R(5), Giannoudis PV(6). Author information: (1)Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Electronic address: hans-christoph.pape@usz.ch. (2)Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. (3)Department of Trauma, University Medical Centre Utrecht, Suite G04.228, Heidelberglaan 100, 3585 GA, Utrecht, the Netherlands. Electronic address: lleenen@umcutrecht.nl. (4)Dept. of Trauma, Emergency Surgery and Critical Care, Harvard University, Mass. General Hospital, 55 Fruit St., Boston, MA, 02114, USA. (5)Section of Orthopedic Trauma, University of Calgary, Foothills Medical Center, 0490 McCaig Tower, 3134 University Drive NW Calgary, Alberta, T2N 5A1, Canada. Electronic address: buckclin@ucalgary.ca. (6)Trauma & Orthopaedic Surgery, Clarendon Wing, A Floor, Great George Street, Leeds General Infirmary University Hospital, University of Leeds, Leeds, LS1 3EX, UK. Electronic address: pgiannoudi@aol.com. OBJECTIVES: Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. METHODS: I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. INCLUSION CRITERIA: adult patients, ISS > 16, admission