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Acute traumatic coagulopathy (ATC) is a condition which occurs in the early post-injury phase in severe trauma patients. It is primarily initiated by traumatic shock or trauma-induced tissue injury. This coagulopathy in severe trauma patients is associated with higher transfusion requirements, longer intensive care unit and hospital stays, prolonged mechanical ventilation support,  a greater incidence of multiple organ failure (MOF) and it is the cause of almost half of the hemorrhagic deaths in trauma patients (Kushimoto, Kudo and Kawazoe, 2017).In the same time, acute traumatic coagulopathy is the most preventable cause of death.ATC occurs in severe trauma patients and it is speculated that the thrombomodulin-protein C system is a principle pathway mediating this ATC. The protein C pathway is characterized as a hyperfibrinolysis and  hypocoagulable state. This means this mechanism is distinct from clotting factor consumption or dysfunction (Brohi, Cohen, Davenport,, 2007). An increased blood loss and an exacerbation of hypovolemic shock will be the result of the hyperfibrinolysis and hypocoagulable state. However, the precise pathophysiologic mechanisms are still under investigation. Another important role in the development of coagulopathy is the lethal triad. This triad consists of hypothermia and acidosis which can initiate the coagulopathy. Naturally, these causes need to be prevented or treated as quickly as possible to prevent development of coagulopathy. Nowadays, the treatment of coagulopathy consists of a balanced transfusion of fresh frozen plasma (FFP) and platelets (1:1). It is important to avoid unnecessary or overtransfusion as transfusion is also associated with higher infection risk, acute respiratory distress syndrome (ARDS) and development of MOF (Balvers, 2016).Besides transfusion with FFP, there is another option: concentrated procoagulant factors. The effectiveness of these factors such as fibrinogen and antifibrinolytics is scientifically proven in severe trauma patients. Since the target audience is severe trauma patients, it is important to start the treatment as quick as possible, as mentioned above.  The focus of this systematic review will be whether and how effective these factors are, if given prehospitally, on the scene.Therefore the research question  is: ”What is the effect of providing procoagulant factors, prehospitally, in severe trauma patients?”. To  answer this research question, international results will be compared in this systematic review. Terms searched in the database Pubmed so far:Terms that still can be used, but can not be found as Mash terms in Pubmed: Severe trauma; severe trauma patients; Hyperfibrinolysishypocoagulable state; procoagulantia; fibrinogen; antifibrinolytics; protein C pathway; dilution; hypothermia; acidose; transfusion. To narrow down the search, Mesh terms are used in the database PubMed. Embase and Google scholar will also be consulted and to select the right articles, a flowchart will be used.Inclusion criteriaStudies from different countries  Articles published in the last 5 to 10 yearStudies with Prehospital administration of procoagulant factorsExclusion criteriaArticles published more than 10 years agoSystematic reviews

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