Abdominal packing for surgically uncontrollable hemorrhage.

Area of Science:

• Trauma Surgery
• Surgical Hemostasis
• Critical Care Medicine

Background:

• Intra-abdominal packing has re-emerged as a strategy for managing surgically uncontrollable hemorrhage.
• This technique is often employed in cases of liver and retroperitoneal injuries, especially when complicated by hypothermia, acidosis, and coagulopathy.

Purpose of the Study:

• To evaluate the efficacy and outcomes of planned intra-abdominal packing for severe hemorrhage.
• To identify risk factors predicting outcomes in patients undergoing this procedure.

Main Methods:

• Retrospective review of 39 patients with liver or retroperitoneal injuries requiring intra-abdominal packing between August 1985 and September 1990.
• Analysis of intraoperative risk factors including pH, temperature, prothrombin time, partial thromboplastin time, and blood transfusion volume.

Main Results:

• Overall mortality was 44%. Exsanguination occurred in 23% of patients.
• Intraoperative risk factors like pH ≤ 7.18, temperature ≤ 33°C, prolonged clotting times, and massive transfusion were highly predictive of mortality.
• Patients with four to five risk factors had a 100% mortality rate, compared to 18% with zero to one risk factor.

Conclusions:

• Intra-abdominal packing can achieve hemostasis in cases of otherwise uncontrollable bleeding, with success in 77% of patients.
• The procedure may prevent or treat the lethal triad of acidosis, hypothermia, and coagulopathy in critically injured patients.
• Careful patient selection based on identified risk factors is crucial for optimizing outcomes.