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Diversity in clinical management and protocols for the treatment of major bleeding trauma patients across European level I Trauma Centres.

Schäfer N, Driessen A, Fröhlich M, Stürmer EK, Maegele M, TACTIC partne - Scand J Trauma Resusc Emerg Med (2015)

Bottom Line: All centres have implemented the immediate use of tranexamic acid.Initial resuscitation is started either pre-hospital or after hospital admission by using transfusion packages with pre-fixed universal blood product combinations and ratios following the concept of "damage control resuscitation" at which applied ratios substantially vary.Two centres initially start with transfusion packages but with viscoelastic tests running in parallel to quickly allow a shift towards a viscoelastic test-guided therapy.

View Article: PubMed Central - PubMed

Affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany.

ABSTRACT

Background: Uncontrolled haemorrhage is still the leading cause of preventable death after trauma and the primary focus of any treatment strategy should be related to early detection and control of blood loss including haemostasis.

Methods: For assessing management practices across six European level I trauma centres with academic interest and research in the field of coagulopathy an online survey was conducted addressing local management practice for bleeding trauma patients including algorithms for detection, management and monitoring coagulation disorders and immediate interventions. Each centre provided their locally applied massive transfusion protocol.

Results: All participating trauma centres have developed and implemented a local algorithm and protocol for the bleeding trauma patient. These are uniformly activated by clinical triggers and deactivated once the bleeding has stopped according to clinical assessment in combination with laboratory signs of achieved haemostasis. The severity of coagulopathy and shock is mostly assessed via standard coagulation tests and partially used extended viscoelastic tests. All centres have implemented the immediate use of tranexamic acid. Initial resuscitation is started either pre-hospital or after hospital admission by using transfusion packages with pre-fixed universal blood product combinations and ratios following the concept of "damage control resuscitation" at which applied ratios substantially vary. Two centres initially start with transfusion packages but with viscoelastic tests running in parallel to quickly allow a shift towards a viscoelastic test-guided therapy.

Conclusion: Diversity in the management of bleeding trauma patients such as pre-hospital blood administration and routinely performed viscoelastic tests exists even among level I trauma centres. The paucity of consensus among these centres highlights the need for further primary research followed by clinical trials to improve the evidence for sophisticated guidelines and strategies.

No MeSH data available.


Related in: MedlinePlus

INTRN-affiliated trauma centres across central and northern Europe
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Fig1: INTRN-affiliated trauma centres across central and northern Europe

Mentions: The founding trauma centres affiliated to the INTRN that are also involved in the EU FP-7 TACTIC project are the Oslo University Hospital Ulleval (Oslo (OSL), Norway), Rigshospitalet Copenhagen (Copenhagen (CPH), Denmark), Academic Medical Centrum (Amsterdam (AMC), The Netherlands), John Radcliffe Hospital (Oxford (OXF), UK), Royal London Hospital (London (RLH), UK), Cologne Merheim Medical Center, University Witten/Herdecke (Cologne (COL), Germany) (Fig. 1).Fig. 1


Diversity in clinical management and protocols for the treatment of major bleeding trauma patients across European level I Trauma Centres.

Schäfer N, Driessen A, Fröhlich M, Stürmer EK, Maegele M, TACTIC partne - Scand J Trauma Resusc Emerg Med (2015)

INTRN-affiliated trauma centres across central and northern Europe
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4590713&req=5

Fig1: INTRN-affiliated trauma centres across central and northern Europe
Mentions: The founding trauma centres affiliated to the INTRN that are also involved in the EU FP-7 TACTIC project are the Oslo University Hospital Ulleval (Oslo (OSL), Norway), Rigshospitalet Copenhagen (Copenhagen (CPH), Denmark), Academic Medical Centrum (Amsterdam (AMC), The Netherlands), John Radcliffe Hospital (Oxford (OXF), UK), Royal London Hospital (London (RLH), UK), Cologne Merheim Medical Center, University Witten/Herdecke (Cologne (COL), Germany) (Fig. 1).Fig. 1

Bottom Line: All centres have implemented the immediate use of tranexamic acid.Initial resuscitation is started either pre-hospital or after hospital admission by using transfusion packages with pre-fixed universal blood product combinations and ratios following the concept of "damage control resuscitation" at which applied ratios substantially vary.Two centres initially start with transfusion packages but with viscoelastic tests running in parallel to quickly allow a shift towards a viscoelastic test-guided therapy.

View Article: PubMed Central - PubMed

Affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany.

ABSTRACT

Background: Uncontrolled haemorrhage is still the leading cause of preventable death after trauma and the primary focus of any treatment strategy should be related to early detection and control of blood loss including haemostasis.

Methods: For assessing management practices across six European level I trauma centres with academic interest and research in the field of coagulopathy an online survey was conducted addressing local management practice for bleeding trauma patients including algorithms for detection, management and monitoring coagulation disorders and immediate interventions. Each centre provided their locally applied massive transfusion protocol.

Results: All participating trauma centres have developed and implemented a local algorithm and protocol for the bleeding trauma patient. These are uniformly activated by clinical triggers and deactivated once the bleeding has stopped according to clinical assessment in combination with laboratory signs of achieved haemostasis. The severity of coagulopathy and shock is mostly assessed via standard coagulation tests and partially used extended viscoelastic tests. All centres have implemented the immediate use of tranexamic acid. Initial resuscitation is started either pre-hospital or after hospital admission by using transfusion packages with pre-fixed universal blood product combinations and ratios following the concept of "damage control resuscitation" at which applied ratios substantially vary. Two centres initially start with transfusion packages but with viscoelastic tests running in parallel to quickly allow a shift towards a viscoelastic test-guided therapy.

Conclusion: Diversity in the management of bleeding trauma patients such as pre-hospital blood administration and routinely performed viscoelastic tests exists even among level I trauma centres. The paucity of consensus among these centres highlights the need for further primary research followed by clinical trials to improve the evidence for sophisticated guidelines and strategies.

No MeSH data available.


Related in: MedlinePlus