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Management of bleeding following major trauma: an updated European guideline

Rolf Rossaint1, Bertil Bouillon2, Vladimir Cerny3, Timothy J Coats4, Jacques Duranteau5, Enrique Fernández-Mondéjar6, Beverley J Hunt7, Radko Komadina8, Giuseppe Nardi9, Edmund Neugebauer10, Yves Ozier11, Louis Riddez12, Arthur Schultz13, Philip F Stahel14, Jean-Louis Vincent15 and Donat R Spahn16*

Author Affiliations

1 Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany

2 Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Hospital Cologne Merheim, Ostmerheimerstrasse 200, 51109 Cologne, Germany

3 Faculty of Medicine in Hradec Králové, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic

4 Accident and Emergency Department, University of Leicester, Infirmary Square, Leicester LE1 5WW, UK

5 Department of Anaesthesia and Intensive Care, University of Paris XI, Faculté de Médecine Paris-Sud, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre, France

6 Department of Emergency and Critical Care Medicine, University Hospital Virgen de las Nieves, ctra de Jaén s/n, 18013 Granada, Spain

7 Guy's & St Thomas' Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK

8 Department of Traumatology, General and Teaching Hospital Celje, 3000 Celje, Slovenia

9 Shock and Trauma Center, S. Camillo Hospital, I-00152 Rome, Italy

10 Institute for Research in Operative Medicine (IFOM), Ostmerheimerstrasse 200, 51109 Cologne, Germany

11 Department of Anaesthesia and Intensive Care, Université Paris Descartes, AP-HP Hopital Cochin, Paris, France

12 Department of Surgery and Trauma, Karolinska University Hospital, 171 76 Solna, Sweden

13 Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology and Lorenz Boehler Trauma Center, Donaueschingenstrasse 13, 1200 Vienna, Austria

14 Department of Orthopaedic Surgery and Department of Neurosurgery, University of Colorado Denver School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA

15 Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium

16 Institute of Anesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland

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Critical Care 2010, 14:R52  doi:10.1186/cc8943

See related letter by Mateo et al.,

Published: 6 April 2010



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.