BACKGROUND: Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma 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 representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. RESULTS: This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately 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 deaths attributable to traumatic injury. CONCLUSION: A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

Department of Anaesthesia Intensive Care and Pain Therapy Consorcio Hospital General Universitario de Valencia Universidad Europea of Valencia Methodology Research Department Avenida Tres Cruces 2 ES 46014 Valencia Spain

Department of Anaesthesia Intensive Care and Perioperative Medicine GHU AP HP Centre Université Paris Cité Cochin Hospital 27 rue du Faubourg St Jacques F 75014 Paris France

Department of Anaesthesiology and Intensive Care Medicine Charles University Faculty of Medicine Simkova 870 CZ 50003 Hradec Králové Czech Republic

Department of Anaesthesiology Intensive Care and Pain Clinic Vall d'Hebron Trauma Rehabilitation and Burns Hospital Autonomous University of Barcelona Passeig de la Vall d'Hebron 119 129 ES 08035 Barcelona Spain

Department of Anaesthesiology Perioperative Medicine and Intensive Care Masaryk Hospital J E Purkinje University Socialni pece 3316 12A CZ 40113 Usti nad Labem Czech Republic

Department of Anaesthesiology University Hospital Aachen RWTH Aachen University Pauwelsstrasse 30 D 52074 Aachen Germany

Department of Anesthesiology Intensive Care and Perioperative Medicine Assistance Publique Hôpitaux de Paris Paris Saclay University 78 rue du Général Leclerc F 94275 Le Kremlin Bicêtre Cedex France

Department of Cardiac Anaesthesia and Intensive Care Prof Dr C C Iliescu Emergency Institute of Cardiovascular Diseases Carol Davila University of Medicine and Pharmacy Sos Fundeni 256 258 RO 022328 Bucharest Romania

Department of Emergency Medicine Emergency County Hospital Sf Spiridon Iasi University of Medicine and Pharmacy Grigore T Popa Iasi Blvd Independentei 1 RO 700111 Iasi Romania

Department of Intensive Care Erasme University Hospital Université Libre de Bruxelles Route de Lennik 808 B 1070 Brussels Belgium

Department of Paediatric and Obstetric Anaesthesia Rigshospitalet University of Copenhagen Blegdamsvej 9 DK 2100 Copenhagen Denmark

Department of Surgery and Trauma Karolinska University Hospital S 171 76 Solna Sweden

Department of Thoracic Anaesthesiology The Heart Centre Rigshospitalet University of Copenhagen Blegdamsvej 9 DK 2100 Copenhagen Denmark

Department of Trauma and Orthopaedic Surgery Cologne Merheim Medical Centre University of Witten Herdecke Ostmerheimer Strasse 200 D 51109 Cologne Germany

Department of Traumatology General and Teaching Hospital Celje Medical Faculty Ljubljana University Oblakova ulica 5 SI 3000 Celje Slovenia

Institute of Anaesthesiology University Hospital Zurich Raemistrasse 100 CH 8091 Zurich Switzerland

Oxford Haemophilia and Thrombosis Centre Nuffield Orthopaedic Centre Oxford University Hospitals NHS Trust Windmill Road Oxford OX3 7HE UK

Radcliffe Department of Medicine Oxford University Oxford UK

Thrombosis and Haemophilia Centre Guy's and St Thomas' NHS Foundation Trust Westminster Bridge Road London SE1 7EH UK

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