Emergency Management of Pelvic Bleeding.

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Surgical Critical Care

Background:

• Pelvic trauma carries a high mortality rate, even with current damage control strategies.
• Hemorrhage control in pelvic fractures remains a significant clinical challenge.

Purpose of the Study:

• To compare the efficacy of Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in managing hemodynamically unstable patients with pelvic trauma.
• To evaluate the impact of EPP and REBOA on mortality and hemodynamic parameters.

Main Methods:

• Retrospective evaluation of patients with blunt pelvic trauma and hemodynamic instability (2002-2018).
• Exclusion criteria included severe brain injury, resuscitative thoracotomy, penetrating trauma, and age < 14.
• Patients were divided into EPP and REBOA Zone III groups; propensity score matching and one-to-one analysis were performed.

Main Results:

• Survival rates were higher in the EPP group, though not statistically significant across all analyzed outcomes (24h, 7-day, overall).
• EPP significantly increased mean arterial pressure (+20.13 mmHg, p < 0.001).
• REBOA demonstrated a greater improvement in mean arterial pressure (+45.10 mmHg, p < 0.001).

Conclusions:

• Both EPP and REBOA are effective interventions that improve hemodynamic status in pelvic trauma patients.
• These techniques represent reasonable initial steps in a multidisciplinary management approach.
• Zone I REBOA may be particularly beneficial for patients in extremis with multi-site torso hemorrhage.