Abdominal packing for surgically uncontrollable haemorrhage

Area of Science:

• Surgical Oncology
• Trauma Surgery
• Critical Care Medicine

Background:

• Abdominal packing is a critical intervention for managing uncontrollable intraoperative hemorrhage.
• While life-saving, packing is associated with significant mortality (56-82%) due to complications like bleeding, abscesses, and compartment syndrome.
• A proactive approach of early abdominal packing, initiated after substantial blood loss (e.g., 6 units), is employed to prevent irreversible patient decline.

Purpose of the Study:

• To analyze the outcomes and identify mortality risk factors associated with early abdominal packing for uncontrollable bleeding.
• To evaluate the effectiveness of early surgical packing in improving survival rates.

Main Methods:

• A retrospective analysis of 49 patients (34 male, 15 female, mean age 43) who underwent abdominal packing for uncontrollable bleeding between January 1997 and September 2008.
• Investigated causes of bleeding including liver trauma, tumors, transplantation, pancreatic necrosectomy, and other miscellaneous conditions.
• Risk factors for mortality were assessed using univariate and multivariate logistic regression analyses.

Main Results:

• Postoperative mortality was 32.7% (16 deaths).
• Univariate analysis identified hypovolemic shock, low urine output, elevated INR, >6 units blood transfusion, hypothermia (<34°C), metabolic acidosis, and sepsis as mortality predictors.
• Multivariate analysis revealed that only hypothermia was a statistically significant independent risk factor for mortality.

Conclusions:

• Early and judicious application of abdominal packing can achieve a reasonable survival rate.
• Preventing or mitigating hypothermia is crucial for improving outcomes in patients undergoing abdominal packing for severe bleeding.