Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 84

 

Home  | About Us | Editors | Search | Ahead Of Print | Current Issue | Archives | Submit Article | Instructions | Subscribe | Contacts | Login 
     
ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 3  |  Page : 148-152

Controlling hemorrhage in exsanguinating pelvic fractures: Utility of extraperitoneal pelvic packing as a damage control procedure


1 Department of Trauma Service, Westmead Hospital, Westmead; Department of Discipline of Surgery, University of Sydney, Sydney, NSW, Australia
2 Department of Trauma Service, Westmead Hospital, Westmead, Sydney, NSW, Australia

Correspondence Address:
Jeremy Ming Hsu
Trauma Service, Level 3, Westmead Hospital, P.O. Box 533, Wentworthville, NSW 2145
Australia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.190655

Rights and Permissions

Introduction: Exsanguinating pelvic fractures are still associated with a significant mortality rate of 28-60%. Extraperitoneal pelvic packing (EPP) has been proposed as an optimal method of early haemorrhage control. The aim of this study was to determine the effect of EPP compared with angioembolization as a primary intervention for patients with exsanguinating pelvic fracture. Method: A prospective observational trial was performed at Westmead Hospital between September 2011 and May 2014. Adult patients with exsanguinating pelvic fracture were allocated into one of two treatment groups determined by the primary/initial haemorrhage control technique: 1. EPP followed by angioembolization or 2. Angioembolization alone. The intervention was determined by the on-call surgeon's proficiency with EPP. Demographic, clinical and laboratory data were collected. Univariate analysis of the two groups was performed with Student's t-test, Mann-Whitney-U test and Fisher's exact test. Results: 24 exsanguinating pelvic fracture cases were included. 14 underwent EPP while 10 underwent angioembolization as the primary intervention. Although not statistically significant, the EPP group was more severely injured (Injury Severity Score 32 vs. 23), more acidotic (base deficit 7.9 vs. 6.2), and more hypotensive (Systolic Blood Pressure 74.2 vs. 84.3). Despite these differences, mortality was reduced (7.1% vs. 30%, not significant). Time to EPP compared with angioembolization was reduced (67.6 vs. 130.2 minutes,P= 0.017). Pre-angioembolization transfusion requirement was also reduced with EPP (0.032 vs. 0.052 units/min,P= 0.04). Arterial injury was found in 51% of the EPP group. There were no significant differences in complication rates between the groups. Conclusion: EPP appears to be a safe and efficient technique for primary haemorrhage control in exsanguinating pelvic fractures. Given the high rate of associated arterial injury, EPP should be considered as the first part of a “damage control” approach for exsanguinating pelvic fractures.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed2295    
    Printed39    
    Emailed0    
    PDF Downloaded112    
    Comments [Add]    
    Cited by others 7    

Recommend this journal