The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: 4E

The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma from Sun Yai-Cheng

The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: Fourth Edition

Rossaint et al. Critical Care (2016) 20:100
DOI 10.1186/s13054-016-1265-x

Major Bleeding

• FAST, CT 找出血
• Damage control surgery if shock or coagulopathy
• Damage control resuscitation 直到找到出血來源並控制
• Restricted volume replacement: target SBP: 80-90 mmHg; severe TBI (GCS ≤8): MAP ≥80 mmHg
• Tranexamic acid (TXA) as early as possible (< 3hr): loading dose TXA 1 g over 10 min, followed by TXA 1 g over 8 h

Transfusion

• Restrictive RBC transfusion: target Hb 7–9 g/dl
• FFP-RBC ratio >1:2
• Fibrinogen maintain at 1.5–2 g/l
• FFP administered to maintain PT and APTT ≤ 1.5 times the normal control
• Platelet count >100K
• PCC administered in patients pre-treated with warfarin or direct-acting oral coagulants
• Off-label use of rFVIIa only if major bleeding and traumatic coagulopathy persist despite standard attempts to control bleeding and best practice use of conventional hemostatic measures.