Intensive Care Medicine

, Volume 37, Issue 4, pp 572–582

Coagulation management in multiple trauma: a systematic review

  • Heiko Lier
  • Bernd W. Böttiger
  • Jochen Hinkelbein
  • Henning Krep
  • Michael Bernhard
Review

DOI: 10.1007/s00134-011-2139-y

Cite this article as:
Lier, H., Böttiger, B.W., Hinkelbein, J. et al. Intensive Care Med (2011) 37: 572. doi:10.1007/s00134-011-2139-y

Abstract

Purpose

The management of trauma patients suffering from active bleeding has improved with a better understanding of trauma-induced coagulopathy. The aim of this manuscript is to give recommendations for coagulation management.

Methods

A systematic literature search in the PubMed database was performed for articles published between January 2000 and August 2009. A total of 230 articles were included in the present systematic review.

Conclusions

The “coagulopathy of trauma” is a discrete disease which has a decisive influence on survival. Diagnosis and therapy of deranged coagulation should start immediately after admission to the emergency department. A specific protocol for massive transfusion should be introduced and continued. Loss of body temperature should be prevented and treated. Acidaemia should be prevented and treated by appropriate shock therapy. If massive transfusion is performed using fresh frozen plasma (FFP), a ratio of FFP to pRBC (packed red blood cells) of 1:2–1:1 should be achieved. Fibrinogen should be substituted at levels of <1.5 g/L. For patients suffering from active bleeding, permissive hypotension (i.e. mean arterial pressure ~65 mmHg) may be aimed for until surgical cessation of bleeding. This option is contraindicated in injuries of the central nervous system and in patients with coronary heart disease, or with known hypertension. Thrombelastography or -metry may be performed to guide coagulation diagnosis and substitution. Hypocalcaemia <0.9 mmol/L should be avoided and may be treated. For actively bleeding patients, pRBC may be given at haemoglobin <10 g/L (6.2 mmol/L) and haematocrit may be targeted at 30%.

Keywords

CoagulopathyTraumaBleedingMassive transfusionThrombelastographyEmergency department

Supplementary material

134_2011_2139_MOESM1_ESM.doc (114 kb)
Supplementary material 1 (DOC 114 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Heiko Lier
    • 1
  • Bernd W. Böttiger
    • 1
  • Jochen Hinkelbein
    • 1
  • Henning Krep
    • 2
  • Michael Bernhard
    • 3
  1. 1.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital CologneCologneGermany
  2. 2.Department of Anaesthesiology and Intensive Care MedicineCatholic Hospital DuisburgDuisburgGermany
  3. 3.Department of Interdisciplinary Emergency MedicineHospital of FuldaFuldaGermany