The past, present, and future management of hemodynamic instability in patients with unstable pelvic ring injuries

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Hemorrhage Control

Background:

• Pelvic ring injuries in hemorrhagic shock historically exceed 30% mortality.
• High mortality necessitates improved management strategies for hemodynamically unstable patients.

Purpose of the Study:

• To evaluate the impact of a revised multi-disciplinary protocol for hemodynamically unstable pelvic ring injuries.
• To assess the efficacy of prioritizing pre-peritoneal pelvic packing over angiography for hemorrhage control.

Main Methods:

• Implementation of a multi-disciplinary protocol since 1993, revised in 2004.
• Prioritization of pre-peritoneal pelvic packing to rapidly control hemorrhage.
• Reduction of high-volume blood transfusions and acute blood loss.

Main Results:

• The revised protocol successfully reduced deaths from hemorrhage by 30%.
• Pre-peritoneal pelvic packing proved effective in rapid hemorrhage control.
• Significant decrease in mortality associated with acute blood loss.

Conclusions:

• Multi-disciplinary protocols are crucial for managing hemodynamically unstable pelvic ring injuries.
• Prioritizing pelvic packing offers a rapid and effective method for hemorrhage control.
• Adoption of such protocols in trauma centers can decrease mortality from acute blood loss.