Management of severe perioperative bleeding: Guidelines from the European Society of Anaesthesiology

Sibylle A. Kozek-Langenecker, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa Alvarez Santullano, Edoardo De Robertis, Daniela C. Filipescu, Dietmar Fries, Klaus Görlinger, Thorsten Haas, Georgina Imberger, Matthias Jacob, Marcus Lancé, Juan Llau, Sue Mallett, Jens Meier, Niels Rahe-Meyer, Charles Marc Samama, Andrew Smith, Cristina Solomon, Philippe Van Der LindenAnne Juul Wikkelsø, Patrick Wouters, Piet Wyffels

Research output: Contribution to journalArticlepeer-review

695 Citations (Scopus)


The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient's tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees and individual expert members of the ESA. Electronic databases were searched without language restrictions from the year 2000 until 2012. These searches produced 20 664 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks and the link was sent to all ESA members. Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

Original languageEnglish
Pages (from-to)270-382
Number of pages113
JournalEuropean Journal of Anaesthesiology
Issue number6
Publication statusPublished - Jun 2013
Externally publishedYes


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