Extraperitoneal Pelvic Packing Research Articles

Extraperitoneal pelvic packing versus angiographic embolization for hemodynamically unstable pelvic fractures: a retrospective single-center analysis.

To retrospectively analyze the clinical data and treatment procedures of angiographic embolization (AE) and extraperitoneal pelvic packing (EPP) for traumatic pelvic fractures in our center for the purpose of providing recommendations on the selection of treatment protocols. We analyzed 110 patients with traumatic pelvic fractures treated with AE and EPP from January 2015 to May 2023. The patients were divided into the AE group (69 men, 41 women) and the EPP group (20 men, 12 women). The primary outcomes were the mortality rate and incidence of complications. The mortality rate was slightly lower in the AE than EPP group (7.3% vs. 9.4%). The overall blood transfusion volume was lower and the length of hospital stay was shorter in the AE than EPP group (7.79 ± 12.04 vs. 9.14 ± 14.21 units and 20.48 ± 11.32 vs. 22.14 ± 10.47 days). Both AE and EPP have good treatment effects. AE is preferred for patients in stable condition with severe hemorrhage. This study suggests that EPP should be the primary treatment and that AE should serve as a complementary treatment for critical patients.

Extraperitoneal pelvic packing in trauma – a review

Pelvic fractures are life-threatening injuries with mortality as high as 40%. The major cause of death is pelvic exsanguination. Extraperitoneal pelvic packing has been suggested in recent years to be an effective method for hemorrhage control. This article briefly reviews the various aspects related to this procedure with emphasis on history, outcomes, technique and complications.

Predictive factors of mortality in patients with pelvic fracture and shock submitted to extraperitoneal pelvic packing.

in recent decades, the extraperitoneal pelvic packing technique has been disseminated, but there are still few studies. Thus, it was decided to analyze the results of extraperitoneal pelvic tamponade, in patients with pelvic fracture and shock, in order to identify predictive factors for mortality. a retrospective review of medical records of patients submitted to extraperitoneal pelvic packing was conduced. We analyzed their characteristics, prehospital and emergency room data, pelvic fracture classification, associated and severity injuries, laboratory and imaging exams, data on packing, arteriography, and other procedures performed, complications, hemodynamic parameters, and amount of transfused blood products before and after packing. data were analyzed from 51 patients, who showed signs of shock from prehospital care, presence of acidosis, with high base deficit and arterial lactate levels. Most patients underwent multiple surgical procedures due to severe associated injuries. The incidence of coagulopathy was 70.58%, and overall mortality was 56.86%. The group of non-surviving patients presented significantly higher age, prehospital endotracheal intubation, and lower Glasgow Coma Scale scores (p<0.05). The same group presented, before and after extraperitoneal pelvic packing, significantly worse hemodynamic parameters of mean arterial pressure, pH, base deficit, hemoglobin, and arterial lactate (p<0.05). The non-surviving group received significantly more units of packed red blood cells, fresh frozen plasma and platelets within 24 hours following extraperitoneal pelvic packing (p<0.05). age and base deficit are independent predictors of mortality in patients submitted to extraperitoneal pelvic packing.

Emergency Management of Pelvic Bleeding.

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.

Infectious complications of extra-peritoneal pelvic packing in emergency room

PurposeThe Extra-Peritoneal Pelvic Packing (EPP) is a procedure used in emergency conditions to control pelvic hemorrhage. This procedure can be performed in Emergency Room (ER) if the patient is too unstable to be transported into the operating room (OR), with a possible increased risk of infections linked to a less sterile environment.MethodsAll patients who underwent EPP from 2009 to 2018 were selected from the trauma registry. The patients were divided into two groups according to where EPP was performed (ER or OR). A Propensity Score Matching was realized. EPP was removed in all patients in the OR after obtaining hemodynamic stabilization within 24–48 h and surgical pads were sent to the laboratory for microbiological analysis.ResultsEighty-four patients underwent EPP during the period of the study. After PSM, 26 couples of patients were selected. No differences were observed between the two groups in the development of pelvic infection. Patients managed in OR showed a higher rate of associated abdominal injuries (p = 0.027) and an increasing need for external fixation (p = 0,005) as well as an increased proportion of laparotomies (p = 0.023), orthopedic interventions (p = 0.005) and a higher systolic blood pressure on admission (p = 0.003).ConclusionsThe EPP is a safe procedure, even when performed out of OR. The EPP in ER allows an earlier control of bleeding in patients in extremis. To minimize the risk of infection, EPP should be removed early, as soon as hemodynamics have been stabilized.

Extraperitoneal packing in unstable blunt pelvic trauma: A single-center study.

Hemodynamically unstable pelvic fractures often require a multi-modal approach including both operative and endovascular management. While an important adjunct in hemorrhage control, time to angioembolization even at the most advanced trauma centers may take hours. Extraperitoneal packing (EPP) is a fast and effective procedure that can immediately address pelvic hemorrhage from the retroperitoneal space in severe pelvic injuries. The aim of this study was to evaluate the efficacy of early EPP, looking at 24 hours and overall mortality, and the hemodynamic impact of EPP in unstable blunt pelvic trauma. All trauma patients admitted to an urban Level I trauma center were evaluated from 2002 to 2018 in a retrospective single-center comparative study. Inclusion criteria were patients 14 years or older who sustained blunt trauma with pelvic fractures and hemodynamic instability. Exclusion criteria were a concomitant head injury (Abbreviated Injury Scale >3) and patients who underwent resuscitative thoracotomy. The patient population was divided into two groups: an EPP group and a no-EPP group. Propensity score matching was used to adjust for differences in baseline characteristics in the two groups: a one-to-one matched analysis using nearest-neighbor matching was performed based on the estimated propensity score of each patient. Two hundred forty-four patients presented hemodynamically unstable, with a pelvic fracture (180 no-EPP, 64 EPP). With propensity score matching, 37 patients in each group were analyzed. Survival within the first 24 hours was significantly improved in the EPP group (81.1% vs. 59.5%, p = 0.042) and we registered similar results in overall survival rate (78.4% EPP group vs. 56.8% no-EPP group, p = 0.047). Those patients who underwent early EPP (n = 64) were associated with a significant improvement in hemodynamic stability, with a pre-EPP mean arterial pressure of 49.9 mm Hg and post-EPP mean arterial pressure of 70.1 mm Hg (p < 0.01). Extraperitoneal pelvic packing is an effective procedure that can be performed immediately, even within the trauma bay, to improve hemodynamic stability and overall survival in patients who sustain severe blunt pelvic trauma. The early use of EPP can be lifesaving. Therapeutic, Level III.

Extraperitoneal pelvic packing in trauma of the pelvis: A standard practice? A general review

Abstract Introduction: Pelvis fractures that associate bleeding with hemodynamic instability warrant immediate treatment. The therapeutic options in these cases vary from angioembolization to extraperitoneal pelvic packing. Material and method: The P.I.C.O.S guidelines were used to structure the questions and the research topic as to attain clinical validity. The results of the research were filtered in accordance with the PRISMA checklist. Results: 38 papers were identified. After screening, 27 papers were used to complete the analysis. Discussion: Frequently, bleeding has a venous source in the pelvis. In the case of pelvic fractures with hemodynamic instability, extraperitoneal pelvic packing is one of the core treatments but not a stand-alone treatment, as it needs to be coupled with a pro-efficient trauma resuscitation protocol. Its intended use is as a bridge therapy until conclusive investigations regarding the place of bleeding can be obtained. Angiography is recommended if hemodynamic instability exists after pelvic packing and effective hemodynamic resuscitation. Conclusion: Even with all these recent efforts, the wide-use of this therapy is precluded due to the absence of a standardized evaluation of these patients and large multicentric studies.

Orthopedic injuries in patients with multiple injuries: Results of the 11th trauma update international consensus conference Milan, December 11, 2017.

In blunt trauma, orthopedic injuries are often associated with cerebral and torso injuries. The optimal timing for definitive care is a concern. The aim of the study was to develop evidence-based guidelines for damage-control orthopedic (DCO) and early total care (ETC) of pelvic and long-bone fractures, closed or open, and mangled extremities in adult trauma patients with and without associated injuries. The literature since 2000 to 2016 was systematically screened according to Preferred Reporting Items for Systematic Reviews and meta-analyses protocol. One hundred twenty-four articles were reviewed by a panel of experts to assign grade of recommendation and level of evidence using the Grading of recommendations Assessment, Development, and Evaluation system, and an International Consensus Conference, endorsed by several scientific societies was held. The choice between DCO and ETC depends on the patient's physiology, as well as associated injuries. In hemodynamically unstable pelvic fracture patient, extraperitoneal pelvic packing, angioembolization, external fixation, C-clamp, and resuscitative endovascular balloon occlusion of the aorta are not mutually exclusive. Definitive reconstruction should be deferred until recovery of physiological stability. In long bone fractures, DCO is performed by external fixation, while ETC should be preferred in fully resuscitated patients because of better outcomes. In open fractures early debridement within 24 hours should be recommended and early closure of most grade I, II, IIIa performed. In mangled extremities, limb salvage should be considered for non-life-threatening injuries, mostly of upper limb. Orthopedic priorities may be: to save a life: control hemorrhage by stabilizing the pelvis and femur fractures; to save a limb: treat soft tissue and vascular injuries associated with fractures, stabilize fractures, recognize, and prevent compartmental syndrome; to save functionality: treat dislocations, articular fractures, distal fractures. While DCO is the best initial treatment to reduce surgical load, ETC should be applied in stable or stabilized patients to accelerate the recovery of normal functions. Systematic review of predominantly level II studies, level II.

Effects of the establishment of a trauma center and a new protocol on patients with hemodynamically unstable pelvic fractures at a single institution in Korea.

The aim of this study was to determine whether the outcomes of patients with hemodynamically unstable pelvic bone fractures changed after the introduction of a protocol including extraperitoneal pelvic packing (EPP) and the establishment of a trauma center. We analyzed data of adult patients (≥ 18years old) with hemodynamically unstable pelvic bone fractures who visited a single trauma center from February 2009 to October 2016. In July 2014, a new protocol for pelvic fractures was implemented, and a trauma center was established. Therefore, patient outcomes were compared by period (period I: pre-protocol vs. period II: post-protocol). Seventy-nine patients with hemodynamically unstable pelvic bone fractures were recruited. The time to angiographic embolization after arrival at the emergency room decreased significantly in period II when compared to period I (182.9 vs. 268.9min, respectively, p < 0.001). The time required to intervention, including EPP, also decreased, from 268.9 ± 132.4min in period I to 141.9 ± 79.9min in period II (p < 0.001). The overall mortality rate decreased from 47.2% in period I to 23.3% in period II (p = 0.033), and mortality related to hemorrhagic shock in particular, was significantly lowered, from 27.8% in period I to 4.7% in period II (p = 0.009). The establishment of a trauma center and the implementation of a new protocol that included EPP were effective in the treatment of patients with hemodynamically unstable pelvic fractures.

Experience of application of extraperitoneal pelvic packing in unstable pelvic ring injuries

OBJECTIVE. Clinical efficacy of extraperitoneal pelvic packing for hemostasis was assessed in patients with unstable pelvic ring injuries and signs of unstable hemodynamics. MATERIAL AND METHODS. The results of treatment were analyzed in 19 patients with hemodynamically unstable pelvic ring injuries. Extraperitoneal pelvic packing was applied in order to stop bleeding after mechanical pelvic stabilization. The evaluation of hemostasis efficacy was performed by using computerized helical tomography with intravenous contrast. RESULTS. The extraperitoneal pelvic packing allowed doctors to achieve stop of bleeding in 14 (73,7 %) patients. CONCLUSIONS. Complex of mechanical stabilization and extraperitoneal pelvic packing of damaged pelvic ring could be actively used in cases of severe injuries for victims in critical conditions.

Extraperitoneal pelvic packing as a way of surgical hemostasis in unstable pelvic injuries

Relevance. Mortality in pelvic injuries reaches 15 % and increases to 45–60 % in case of hemodynamic instability due to continuous massive bleeding. Intention. To determine the effectiveness of extraperitoneal pelvic packing (EPP) for surgical hemostasis in patients with unstable pelvic injuries and unstable hemodynamics. Methods. We analyzed treatment of 22 patients with unstable pelvic injuries and signs of hemodynamic instability in 2 firstlevel trauma clinics (St. Petersburg, 2013–2017). In all cases EPP was performed after mechanical stabilization of the pelvic ring to stop bleeding. Before and after EPP, the following hemostatis parameters were assessed: systolic blood pressure, volume of blood transfused, pH and base deficit, arterial blood lactate. Pelvic angiography was used to control and verify arterial bleeding sources. Results and Discussion. EPP made it possible to stop the ongoing pelvic bleeding in 14 (73.7 %) patients. EPP effectiveness was confirmed by statistically significant changes in mean systolic BP before and after packing, and a 3:1 ratio of the average volume of blood transfusion therapy. The total mortality rate was 14 (63.6 %) cases, 5 (22.7 %) patients died during the first day (mainly from irreversible blood loss), 9 patients (40.9 %) died within the first two weeks due to infectious complications. Our results are consistent with literature data. Conclusion. Extraperitoneal pelvic packing can be widely used in combination with mechanical stabilization of the damaged pelvic ring in patients with severe pelvic injuries. EPP does not exclude subsequent angiography and angioembolization.

Management Strategy of Bleeding Pelvic Fracture

Although there have been some improvements in mortality and morbidity associated with bleeding pelvic fractures, patients with unstable pelvic fracture are still a therapeutic challenge for the trauma surgeon. Outcomes may be improved through multidisciplinary approaches to control hemorrhage and temporarily stabilize the fracture. Angioembolization has been successfully used for decades but there are some limitations. Recently, pelvic stabilization with extraperitoneal pelvic packing was introduced as an alternative or adjunctive therapy. Appropriate management algorithm is needed to successfully manage patients with pelvic bone fracture. Key Words: Hemorrhage; Pelvis; Fractures, Bone; Therapy

Reduced need for extraperitoneal pelvic packing for severe pelvic fractures is associated with improved resuscitation strategies.

Extraperitoneal pelvic packing (EPP) was introduced at Oslo University Hospital Ulleval (OUHU) in 1994. Published studies from other institutions have advocated its application as a first-line therapy in lieu of angiography. Extraperitoneal pelvic packing is invasive with a high risk of complications, and its role remains an issue of discussion. In line with international trends, an updated massive hemorrhage protocol was implemented at OUHU in 2007. We hypothesized a decreased need for EPP owing to the major changes in resuscitation strategies. Retrospective analysis of data from the OUH Trauma Registry and patient charts for the period 2002-2012 was performed. All pelvic fractures with Abbreviated Injury Severity (AIS) score of 3 or higher and/or transfused during the period before intensive care unit admission regardless of the pelvic AIS were included. The population was analyzed for trends and differences between 2002-2006 (P1) and 2007-2012 (P2). Further analysis was performed on the group of patients transfused five or more units of red blood cells (RBCs). We included 648 patients (P1, 297; P2, 351). There was no difference in median injury severity score, pelvic AIS, or age between the two periods. Median base deficit on admission was higher in P2 (4.2 vs 3.3 mmol/L; p < 0.01). The EPP rate decreased from P1 to P2 (17-10%; p < 0.01). A similar reduction in the angiography rate (15% vs 9%; p < 0.01) was observed, with a concomitant decrease in hemorrhage-related deaths (10% vs 5%; p = 0.01). The subgroup analysis of patients transfused five or more units of RBCs revealed significant increase in the use of plasma and platelets in P2. Multiple logistic regression models for the subgroup transfused five or more units of RBCs confirm the change in resuscitation strategy to be significantly associated with reduced EPP, and identifying admission in P2 to be associated with a 63% decreased odds ratio for EPP. The EPP and angiography rates for exsanguinating pelvic injuries have decreased with improved resuscitation strategies, reducing RBC requirements and hemorrhage-related deaths. Therapeutic study, level IV.

Efficacy of extra-peritoneal pelvic packing in hemodynamically unstable pelvic fractures, a Propensity Score Analysis.

BackgroundAn option for emergency control of pelvic hemorrhage is Extra-peritoneal Pelvic Packing (EPP), which addresses the retroperitoneal source of exsanguination in pelvic fractures. The aim of this study was to demonstrate the efficacy of early EPP in reducing mortality due to hemorrhage from pelvic fractures, and to evaluate the impact of packing on transfusion requirements within the first 24 h and ICU length of stay (ICU-LOS).All data pertaining trauma patients admitted from October 2002 and December 2103 with hemodynamic instability and pelvic fractures were selected from the Hospital Trauma Registry. Patients with severe brain injury and bleeding from extra-pelvic sources were excluded. Patient population was divided into two groups: EPP group, including patients admitted from 2009 to 2013, with EPP as part of the treatment algorithm, and NO-EPP group, from 2002 to 2008, without EPP as atherapeutic option. Descriptive statistical analysis was performed on allpatients. Twenty-five patients of each group with similar features were matched using Propensity Score Analysis (PSA).ResultsSix hundred eighty out of 4659 major trauma (14.6 %) presented a pelvic fracture. In 78 hemodynamically unstable patients (30 in EPP group,48 in NO-EPP group) the major source of bleeding was the pelvis. Among patients selected by PSA early mortality was significantly reduced in EPP group (20 vs 52 %, p = .03) compared to NO-EPP, notwithstanding similar hemodynamic impairment. No difference was observed in transfusion requirements and ICU-LOS.ConclusionsThe EPP is a safe and quick procedure, able to improve hemodynamic stabilization and to reduce acute mortality due to hemorrhage in patients with pelvic fracture, in combination with optimized transfusion protocol. EPP may be useful as a bridge for time-consuming procedures, such as angio-embolization.

Penetrating pelvic trauma: Initial assessment and surgical management in emergency

Penetrating pelvic trauma (PPT) is defined as a wound extending within the bony confines of the pelvis to involve the vascular, intestinal or urinary pelvic organs. The gravity of PPT is related to initial hemorrhage and the high risk of late infection. If the patient is hemodynamically unstable and in hemorrhagic shock, the urgent treatment goal is rapid achievement of hemostasis. Initial strategy relies on insertion of an intra-aortic occlusion balloon and/or extraperitoneal pelvic packing, performed while damage control resuscitation is ongoing before proceeding to arteriography. If hemodynamic instability persists, a laparotomy for hemostasis is performed without delay. In a hemodynamically stable patient, contrast-enhanced CT is systematically performed to obtain a comprehensive assessment of the lesions prior to surgery. At surgery, damage control principles should be applied to all involved systems (digestive, vascular, urinary and bone), with exteriorization of digestive and urinary channels, arterial revascularization, and wide drainage of peri-rectal and pelvic soft tissues. When immediate definitive surgery is performed, management must address the frequent associated lesions in order to reduce the risk of postoperative sepsis and fistula.

Controlling hemorrhage in exsanguinating pelvic fractures: Utility of extraperitoneal pelvic packing as a damage control procedure.

Introduction:Exsanguinating pelvic fractures are still associated with a significant mortality rate of 28-60%. Extraperitoneal pelvic packing (EPP) has been proposed as an optimal method of early haemorrhage control. The aim of this study was to determine the effect of EPP compared with angioembolization as a primary intervention for patients with exsanguinating pelvic fracture.Method:A prospective observational trial was performed at Westmead Hospital between September 2011 and May 2014. Adult patients with exsanguinating pelvic fracture were allocated into one of two treatment groups determined by the primary/initial haemorrhage control technique: 1. EPP followed by angioembolization or 2. Angioembolization alone. The intervention was determined by the on-call surgeon's proficiency with EPP. Demographic, clinical and laboratory data were collected. Univariate analysis of the two groups was performed with Student's t-test, Mann-Whitney-U test and Fisher's exact test.Results:24 exsanguinating pelvic fracture cases were included. 14 underwent EPP while 10 underwent angioembolization as the primary intervention. Although not statistically significant, the EPP group was more severely injured (Injury Severity Score 32 vs. 23), more acidotic (base deficit 7.9 vs. 6.2), and more hypotensive (Systolic Blood Pressure 74.2 vs. 84.3). Despite these differences, mortality was reduced (7.1% vs. 30%, not significant). Time to EPP compared with angioembolization was reduced (67.6 vs. 130.2 minutes, P = 0.017). Pre-angioembolization transfusion requirement was also reduced with EPP (0.032 vs. 0.052 units/min, P = 0.04). Arterial injury was found in 51% of the EPP group. There were no significant differences in complication rates between the groups.Conclusion:EPP appears to be a safe and efficient technique for primary haemorrhage control in exsanguinating pelvic fractures. Given the high rate of associated arterial injury, EPP should be considered as the first part of a “damage control” approach for exsanguinating pelvic fractures.

Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: A content analysis and expert appropriateness rating study.

The use of abbreviated or damage control (DC) interventions may improve outcomes in severely injured patients when appropriately indicated. We sought to determine which indications for DC interventions have been most commonly reported in the peer-reviewed literature to date and evaluate the opinions of experts regarding the appropriateness (expected benefit-to-harm ratio) of the reported indications for use in practice. Two investigators used an abbreviated grounded theory method to synthesize indications for 16 different DC interventions reported in peer-reviewed articles between 1983 and 2014 into a reduced number of named, content-characteristic codes representing unique indications. For each indication code, an international panel of trauma surgery experts (n = 9) then rated the appropriateness of conducting the DC intervention of interest in an adult civilian trauma patient. The 424 indications identified in the literature were synthesized into 101 unique indications. The panel assessed 12 (70.6%) of the coded indications for the 7 different thoracic, 47 (78.3%) for the 7 different abdominal/pelvic, and 18 (75.0%) for the 2 different vascular interventions to be appropriate for use in practice. These included indications for rapid lung-sparing surgery (pneumonorrhaphy, pulmonary tractotomy, and pulmonary wedge resection) (n = 1); pulmonary tractotomy (n = 3); rapid, simultaneously stapled pneumonectomy (n = 1); therapeutic mediastinal and/or pleural space packing (n = 4); temporary thoracic closure (n = 3); therapeutic perihepatic packing (n = 28); staged pancreaticoduodenectomy (n = 2); temporary abdominal closure (n = 12); extraperitoneal pelvic packing (n = 5); balloon catheter tamponade (n = 6); and temporary intravascular shunting (n = 11). This study identified a list of candidate appropriate indications for use of 12 different DC interventions that were suggested by authors of peer-reviewed articles and assessed by a panel of independent experts to be appropriate. These indications may be used to focus future research and (in the interim) guide surgical practice while studies are conducted to evaluate their impact on patient outcomes.

What's new in emergencies, trauma and shock? Extraperitoneal pelvic pressure packing: Placing this procedure in context.

What's new in emergencies, trauma and shock? Extraperitoneal pelvic pressure packing: Placing this procedure in context.

La gestione del paziente emodinamicamente instabile con frattura di bacino

The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk. In particular, patients “in extremis” are at high risk of dying. This patient group is characterised by absent vital signs or by being in severe shock with initial systolic blood pressure 12 blood transfusions within the first two hours after admission. The source of pelvic bleeding has in approximately 80–90% of cases a venous origin and relevant arterial bleeding accounts for 10–20%. Important parts of the initial treatment include mechanical pelvic ring stabilization combined with haemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation (C-clamp), depending on local available resources. In patients “in extremis”, direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistent haemodynamic instability occurs despite shock therapy and mechanical stabilisation and pelvic packing, arterial injury is ruled out by angiography followed by selected embolisation of pelvic vessels.

Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the

Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients.Hemodynamically Unstable Pelvic Trauma is a frequent death cause among people who sustain blunt trauma. We present the results of the First Italian Consensus Conference.