Professional circles discuss European guidelines on the approach to severe traumatic bleeding

Wittlich. At the end of 2007, the professional journal "Critical Care" published new guidelines for the treatment of patients with massive bleeding as a result of serious injuries. The interdisciplinary project group “Task Force for Advanced Trauma Care in Bleeding" – it has existed since 2005 and is made up of European experts and specialised companies - has issued recommendations for action in the case of severe traumatic bleeding based on a consensus of all participants following critical intensive screening and assessment of the available literature. These recommendations were evaluated with regard to their evidence and classified accordingly. The division into the evidence stages 1A, 1B, 1C, 2A, 2B and 2C was named after the so-called GRADE system (Grading of Recommendations Assessment, Development, and Evaluation). The recommendations are only guidelines.

Thus the time span between trauma and surgery for patients who urgently need surgical control of bleeding should to be minimised. In Germany, it takes an average of 75 minutes before a severely injured person gets to the hospital - in some cases much longer (Source: German Society of Trauma Surgery, Trauma Register).

Patients in hemorrhagic shock and with an identified source of bleeding should undergo immediate surgical bleeding control unless initial therapeutic measures are immediately successful.

Surgical treatment in accordance with the "Damage Control" concept is essential in the treatment of severely injured patients. Pelvic ring fractures should be closed and stabilised, followed by an angiographic arterial embolisation or surgical bleeding control, including "packing" with abdominal blankets.

Patients in volume depletion shock and bleeding from an unidentified source should undergo further investigation such as focused sonography or computer tomography (CT), the measurement of serum lactates and/or the measurement of the basic deviations. The guideline also includes information on physiological target levels (blood pressure, normothermia, hemoglobin) and dosages for blood products and clotting factors for patients suffering from traumatic bleeding.
(The original text can be read here in an HTML version or downloaded free as a PDF. For more information, see also www.advancedbleedingcare.org)