Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution. The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013. The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome. A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.

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

Idarucizumab for dabigatran reversal

2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery.

The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limite

Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology.

The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to

/pdf/management-of-severe-perioperative-bleeding-guidelines-from-2wdggnur4g.pdf

Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016.

A number of studies have demonstrated wide interhospital variation in transfusion practice in surgical patients and the critically ill. The extent of the variation suggests that a significant number of allogenic transfusions may not have an adequate indication. There are manifold reasons for this variation, ranging from different patient populations, differences in perioperative blood loss, to inappropriate use of blood products. This not only influences perioperative costs, but also has significant impact on perioperative outcomes. In this context, it has been proven by several groups in different patient populations, that a restrictive transfusion regime is at least as good as, if not better than, a liberal regime. What so far remains unknown is whether this knowledge has changed daily clinical practice. Gombotz et al. have shown that, despite the evidence that has emerged to date, significant differences in perioperative transfusion practice still exist. This experience has recently been corroborated by Hutton et al. and Bennett-Guerrero et al.

Juan V.L. Pitarch

Papers

Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016.

ESA Clinical Trials Network 2012: ETPOS--European Transfusion Practice and Outcome Study.