Abstract
Pelvic trauma continues to have a high mortality rate despite damage control techniques for bleeding control. The aim of our study was to evaluate how Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) impact the efficacy on mortality and hemodynamic impact. We retrospectively evaluated patients who sustained blunt trauma, pelvic fracture and hemodynamic instability from 2002 to 2018. We excluded a concomitant severe brain injury, resuscitative thoracotomy, penetrating trauma and age below 14 years old. The study population was divided in EPP and REBOA Zone III group. Propensity score matching was used to adjust baseline differences and then a one-to-one matched analysis was performed. We selected 83 patients, 10 for group: survival rate was higher in EPP group, but not significantly in each outcome we analyzed (24 h, 7 day, overall). EPP had a significant increase in main arterial pressure after procedure (+20.13 mmHg, p < 0.001), but this was not as great as the improvement seen in the REBOA group (+45.10 mmHg, p < 0.001). EPP and REBOA are effective and improve hemodynamic status: both are reasonable first steps in a multidisciplinary management. Zone I REBOA may be useful in patients ‘in extremis condition’ with multiple sites of torso hemorrhage, particularly those in extremis.
Highlights
Management of traumatic pelvic fractures is one of the most complex challenges for trauma surgeons
In the previous work from our group, we analyzed 322 patients according to our inclusion criteria: after exclusion criteria and Propensity Score Matching our study population was seventy-four patients, 37 in no-Extra-Peritoneal Packing (EPP) and 37 in EPP group
We demonstrated Extra-Peritoneal Packing was an effective procedure, improving 24 h and overall survival in contrast with no-EPP group (p = 0.042, p = 0.047)
Summary
Management of traumatic pelvic fractures is one of the most complex challenges for trauma surgeons. The mortality rate remains high in hemodynamically unstable patients after an acute post-traumatic pelvic hemorrhage. The mortality rate can be greater than. 40% due to rapid exsanguination [1,2]. A multimodal treatment approach in pelvic trauma has been the gold standard. This includes an early mechanical stabilization with pelvic binder, when necessary, and both operative management—Extra-Peritoneal Packing (EPP)—and endovascular interventions—such as Angio-Embolization procedures (AE) or Resuscitative Endovascular. Every type of emergency treatment must be considered in according with the stability, force direction and patoanathomy of pelvic fractures, looking for example to ‘Tile’ or ‘Young and Burgess’ classification. Every type of emergency treatment must be considered in according with the stability, force direction and patoanathomy of pelvic fractures, looking for example to ‘Tile’ or ‘Young and Burgess’ classification. [3,4,5,6,7]
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