Abstract
BackgroundUncontrolled 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.MethodsFor 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.ResultsAll 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.ConclusionDiversity 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0147-6) contains supplementary material, which is available to authorized users.
Highlights
Modern trauma care has demonstrated to lower mortality by creating multidisciplinary evidence-based treatment algorithms for the bleeding trauma patient, by creating awareness among the involved medical specialties and by improving mutual understanding [1, 2]
Trauma centres The founding trauma centres affiliated to the International Trauma Research Network (INTRN) that are involved in the EU FP-7 TACTIC project are the Oslo University Hospital Ulleval (Oslo (OSL), Massive transfusion protocols (MTPs) and algorithms Each centre was further requested to provide their local treatment algorithms and massive transfusions protocols that are activated for the management of bleeding trauma patients in their local settings
Characterization of the six trauma centres Trauma centres in London and Oslo receive the greatest number of severely injured patients (ISS ≥16) with more than 400 patients admitted per year, followed by Copenhagen (301–400 patients), Amsterdam and Oxford (201–300 patients), and Cologne (101–200 patients; Table 1)
Summary
Modern trauma care has demonstrated to lower mortality by creating multidisciplinary evidence-based treatment algorithms for the bleeding trauma patient, by creating awareness among the involved medical specialties and by improving mutual understanding [1, 2]. Most facilities have implemented guidelines and protocols to quickly assess and treat trauma patients to date, there is high diversity in clinical practice including diagnosis of major bleeding and trauma-induced coagulopathy [3, 4, 12,13,14,15,16]. These protocols may vary depending upon local infrastructure and logistics, making outcome comparisons between individual centres rather difficult. 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
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