Bleeding management in pelvic trauma: state of the art

Bleeding complications from pelvic injuries occur after high-energy trauma as well as after low-energy trauma in elderly patients and are the main contributors to mortality. Demographic changes necessitate focussing on both entities and targeted therapies throughout the course of management.

This article reviews the recent evidence and expertise on bleeding management for haemodynamically unstable patients with pelvic fractures with insights from prehospital care to trends in resuscitation and endovascular techniques and revival of older strategies, to challenges of definitive treatment. It also takes a closer look into pelvic fractures of the elderly and their most recent treatment options.

Bleeding management in pelvic trauma begins prehospitally with targeted transportation, infusion of crystalloids and blood products, and a differentiated use of pelvic binders. In the emergency department, care involves rapid evaluation, massive transfusion protocols and computed tomography (CT) angiography. Resuscitative Endovascular Balloon Occlusion of the Aorta can serve as bridging to diagnostics and bleeding control. Bleeding control management includes mechanical stabilization, preperitoneal pelvic packing or angioembolization. In elderly patients, rigid vessels and anticoagulation contribute to bleeding complications. Selective CT angiography is advised for certain injury patterns and haemodynamic instability. Depending on bleeding localization, selective angioembolization is preferred.