MANAGEMENT OF BLEEDING AFTER MAJOR TRAUMA: A EUROPEAN GUIDELINE – WHAT’S NEW?

Trauma was published in the prestigious Critical Care [1]. It emerged from a multidisciplinary Task Force for Advanced Bleeding Care in Trauma formed in 2005 with the aim of developing evidence-based recommendations. Relying upon a systematic review of published literature recommendations were formulated after group discussions and according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) hierarchy. Certainly in the modern world trauma is a topic of major interest. It is the leading cause of death for young people and is correlated with high costs, loss of lives or long-lasting disabilities. Uncontrolled bleeding is responsible for 30-40 % of trauma-related death, but of most interest it is the major potentially preventable cause of early in-hospital mortality [1]. Persistent blood hypotension (systolic blood pressure less than 70mmHg) is associated with coagulopathy and poor outcome. Not only trauma is responsible of uncontrolled bleeding, but also the therapeutic intervention. Early aggressive volume repletion may lead to pathophysiological disturbances, which perpetuate haemorrhage: the bloody vicious cycle