The European Trauma Course (ETC) and the team approach: past, present and future.

The European Trauma Course (ETC) was officially launched during the international conference of the European Resuscitation Council (ERC) in 2008. The ETC was developed on behalf of ESTES (European Society of Trauma and Emergency Surgery), EuSEM (European Society of Emergency Medicine), the ESA (European Society of Anaesthesiology) and the ERC. The objective of the ETC is to provide an internationally recognised and certified life support course, and to teach healthcare professionals the key principles of the initial care of severely injured patients. Its core elements, that differentiates it from other trauma courses, are a strong focus on team training and a novel modular design that is adaptable to the differing regional European requirements. This article describes the lessons learnt during the European Trauma Course development and provides an outline of the planned future development.

Experience of recombinant activated factor VII (NovoSeven) in the operating theatre and intensive care unit for the management of intracranial bleeding in nonhaemophilic patients.

OBJECTIVE: Intracranial haemorrhage (ICH) is associated with high morbidity and mortality. Our aim was to explore the use of recombinant activated factor VII (rFVIIa NovoSeven Novo Nordisk, A/S, Bagsvaerd, Denmark) for the management of ICH in the operating theater and intensive care unit. PATIENTS AND METHODS: We reviewed all the records of nonhaemophilic patients entered into the haemostasis.com database who received rFVIIa for ICH. RESULTS: Sixteen suitable patients were identified (mean age: 23.3 years; range: 1-58 years). The total dose of rFVIIa administered ranged from 31 to 270 microg/kg. Indications were stabilization of ICH (n=6), control of peri- or post-operative haemorrhage associated with neurosurgical procedures (n=8), or correction of coagulopathy prior to neurosurgical intervention (n=2). The majority (13/16 [81.25%]) required one dose of rFVIIa. A clinical effect (stabilization of bleed, reduction of peri- or post-operative haemorrhage, or prevention of excessive blood loss during neurosurgery) was seen in 14/16 (87.5%) patients. Some improvement in coagulation status was noted. No thromboembolic events were reported. One patient experienced massive elevation of D-dimer levels-an effect possibly due to rFVIIa. Two patients suffered adverse events unrelated to rFVIIa. Six deaths occurred, all attributable to underlying brain injury. CONCLUSION: This observational study suggests that rFVIIa is of value for the management of ICH in nonhaemophilic patients secondary to a range of aetiologies. These findings justify further investigation.