Maegele Marc, Nardi Giuseppe, Schöchl Herbert
aDepartment for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC) bInstitute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Köln, Germany cDepartment for Anesthesiology and Intensive Care Medicine, Ospedali di Rimini e Riccione, AUSL della Romagna, Rimini, Italy dDepartment for Anesthesiology and Intensive Care Medicine, AUVA Trauma Hospital, Salzburg, Austria.
Curr Opin Anaesthesiol. 2017 Apr;30(2):257-264. doi: 10.1097/ACO.0000000000000433.
This review presents a synopsis of best current knowledge with reference to the updated German and European guidelines and recommendations on the management of severe trauma hemorrhage and trauma-induced coagulopathy as well as a viscoelastic-based treatment algorithm based upon international expert consensus to trigger the administration of hemostatic agents and blood products.
Uncontrolled hemorrhage and trauma-induced coagulopathy are the major causes for preventable death after trauma and early detection and aggressive management have been associated with improved outcomes. However, best practice to treat this newly defined entity is still under debate. In the acute phase, the clinical management usually follows the 'Damage Control Resuscitation' concept, which advocates the empiric administration of blood products in predefined and fixed ratios. As an alternative, several European but also a few US trauma centers have instituted the concept of 'Goal-directed Coagulation Therapy' based upon results obtained from early point-of-care viscoelastic testing.
Current guidelines urge for the implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome.
本综述参考德国和欧洲关于严重创伤出血及创伤性凝血病管理的最新指南与建议，概述当前最佳知识，并介绍基于国际专家共识的基于粘弹性的治疗算法，以触发止血剂和血液制品的使用。
失控性出血和创伤性凝血病是创伤后可预防死亡的主要原因，早期检测和积极管理与改善预后相关。然而，治疗这个新定义实体的最佳实践仍在争论中。在急性期，临床管理通常遵循“损伤控制复苏”概念，该概念主张按预定固定比例经验性使用血液制品。作为替代方案，一些欧洲以及少数美国创伤中心基于早期床旁粘弹性检测结果，采用了“目标导向凝血治疗”概念。
当前指南敦促实施基于证据的本地方案和算法，包括临床质量和安全管理系统以及评估出血控制和预后关键指标的参数。
