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Extraperitoneal pelvic packing: a salvage procedure to control massive traumatic pelvic hemorrhage
Anna Tötterman1, Jan Erik Madsen, Nils Oddvar Skaga
1Orthopedic Centre, Ullevål University Hospital, Oslo, Norway. anna.totterman@ulleval.no
Insights
Extraperitoneal pelvic packing (EPP) may save lives in patients with exsanguinating pelvic injuries. This trauma intervention should be followed by angiography to address arterial injuries.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Surgical Critical Care
Background:
- Blunt pelvic trauma can cause life-threatening hemorrhage.
- Hemodynamic instability poses significant challenges in managing pelvic trauma.
Purpose of the Study:
- To describe the extraperitoneal pelvic packing (EPP) technique.
- To evaluate the impact of EPP on outcomes in severely hemodynamically unstable patients with blunt pelvic trauma.
Main Methods:
- Retrospective review of 18 patients undergoing EPP for pelvic trauma.
- Data collected included demographics, fracture patterns, interventions, and survival rates.
- Physiologic parameters and blood transfusion requirements were analyzed.
Main Results:
- Survival rate within 30 days was 72% (13/18).
- EPP led to a significant increase in systolic blood pressure (p = 0.002).
- 80% of patients showed arterial injury on post-EPP angiography.
Conclusions:
- EPP can be life-saving in exsanguinating pelvic injury patients.
- Angiography is crucial post-EPP to manage identified arterial injuries.
- EPP should be part of a multi-interventional resuscitation protocol for severe pelvic trauma.
Objective:
To describe the method of extraperitoneal pelvic packing (EPP), and to assess the impact of EPP on outcome in severely hemodynamically unstable patients after blunt pelvic trauma.
Methods:
Of 661 patients treated for pelvic trauma, 18 underwent EPP as part of our protocol with the intent to control massive pelvic bleeding and constituted the study population. Data retrospectively collected from the medical records and from the Ullevål Trauma Registry included demographics, fracture classification, additional injuries, blood transfusions, surgical interventions, angiographic procedure, physiologic parameters, and survival.
Results:
Survival rate within 30 days was 72% (13/18), and correlated inversely to the age of the patient (p = 0.038). Only one of the nonsurvivors died of exsanguination. A significant increase in systolic blood pressure (BP) (p = 0.002) was observed immediately after EPP. Angiography performed after EPP was positive for arterial injury in 80% of patients. All types of pelvic ring fractures were represented.
Conclusions:
EPP as part of a multi-interventional resuscitation protocol might be life saving in patients with life-threatening pelvic injury who are exsanguinating. However, the high rate of arterial injuries seen after EPP indicates that the procedure should be supplemented with angiography once the patient is sufficiently stabilized to tolerate transportation to the angiography suite.
