Rossaint etal.Critical Care (2023)27:80Critical Carehttp5/dol.org/10.1186/s13054-023-04327-7GUIDELINESOpen AccessThe European guideline on managementeck 1oof major bleeding and coagulopathyfollowing trauma:sixth editionRolf Rossaint1,Arash Afshari2,Bertil Bouillon3,Vladimir Cemy.5,Diana Cimpoesu,Nicola Curry78Jacques Duranteau,Daniela Filipescu Oliver Grottke',Lars Gronlykke1,Anatole Harrois,Beverley J.Hunt2,Alexander Kaserer,Radko Komadina4,Mikkel Herold Madsen2,Marc Maegele5,Lidia Mora,Louis Riddez7Carolina S.Romero,Charles-Marc Samama19,Jean-Louis Vincent20,Sebastian Wiberg11 and Donat R.Spahn3AbstractBackground Severe trauma represents a major global public health burden and the management of post-traumaticbleeding continues to challenge healthcare systems around the world.Post-traumatic bleeding and associated trau-matic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosedand managed in an appropriate and timely manner.This sixth edition of the European guideline on the managementof major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleedingtrauma patient during the initial diagnostic and therapeutic phases of patient management.Methods The pan-European,multidisciplinary Task Force for Advanced Bleeding Care in Trauma included repre-sentatives from six European professional societies and convened to assess and update the previous version of thisguideline using a structured,evidence-based consensus approach.Structured literature searches covered the periodsince the last edition of the guideline,but considered evidence cited previously.The format of this edition has beenadjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies andmost relevant literature rather than attempting to provide a comprehensive literature review to accompany eachrecommendation.Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal pathfor management of the bleeding trauma patient,with recommendations grouped behind key decision points.Whileapproximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state,a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deathsattributable to traumatic injury.Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice inthe management of severely injured trauma patients.Further improvement in outcomes will be achieved by optimis-ing and standardising trauma care in line with the available evidence across Europe and beyond.*Correspondence:Rolf RossaintRRossaint@ukaachendeFull list of author infor mation is available at the end of the articleBMCThe Author(s)2023.Open AccessThis artidle is licensed undera Creative Commons Attribution 40 Intemnational License,whichpermits use,sharing ada
