BACKGROUND: Preperitoneal pelvic packing/external fixation (PPP/EF) for controlling life-threatening hemorrhage from pelvic fractures is used widely in Europe but has not been adopted in North America. We hypothesized that PPP/EF arrests hemorrhage rapidly, facilitates emergent operative procedures, and ensures efficient use of angioembolization (AE). STUDY DESIGN: In 2004 we initiated a PPP/EF guideline for pelvic fracture patients with refractory shock requiring ongoing blood transfusion at our regional trauma center. RESULTS: Among 1,245 patients admitted with pelvic fractures, 75 consecutive patients underwent PPP/EF (age 42 ± 2 years and injury severity score 52 ± 1.5). Emergency department systolic blood pressure was 76 ± 2 mmHg and heart rate 119 ± 2 beats/min. Time to operation was 66 ± 7 minutes, and 65 patients (87%) underwent 3 ± 0.3 additional procedures. Blood transfusion before PPP/EF compared with the first postoperative 24 hours was 10 ± 0.8 units versus 4 ± 0.5 units (p < 0.05). The fresh frozen plasma-red blood cell ratio was 1:2. After PPP/EF, 10 patients (13%) underwent angioembolization with a documented blush; time to angioembolization was 10.6 ± 2.4 hours (range 1 to 38 hours). Mortality for all pelvic fractures was 8%, with 21% mortality in this high-risk group. There were no deaths due to acute hemorrhage. CONCLUSIONS: PPP/EF was effective in controlling hemorrhage from unstable pelvic fractures. None of these high-risk patients died due to pelvic bleeding. Secondary angioembolization was needed in a minority, permitting selective use of this resource-demanding intervention. Additionally, PPP/EF temporizes arterial hemorrhage, providing valuable transfer time for facilities without angiography. With other urgent operative interventions required in >85% of patients, combining these procedures with PPP/EF for operative pelvic hemorrhage control appears to optimize patient care.
BACKGROUND: Preperitoneal pelvic packing/external fixation (PPP/EF) for controlling life-threatening hemorrhage from pelvic fractures is used widely in Europe but has not been adopted in North America. We hypothesized that PPP/EF arrests hemorrhage rapidly, facilitates emergent operative procedures, and ensures efficient use of angioembolization (AE). STUDY DESIGN: In 2004 we initiated a PPP/EF guideline for pelvic fracturepatients with refractory shock requiring ongoing blood transfusion at our regional trauma center. RESULTS: Among 1,245 patients admitted with pelvic fractures, 75 consecutive patients underwent PPP/EF (age 42 ± 2 years and injury severity score 52 ± 1.5). Emergency department systolic blood pressure was 76 ± 2 mmHg and heart rate 119 ± 2 beats/min. Time to operation was 66 ± 7 minutes, and 65 patients (87%) underwent 3 ± 0.3 additional procedures. Blood transfusion before PPP/EF compared with the first postoperative 24 hours was 10 ± 0.8 units versus 4 ± 0.5 units (p < 0.05). The fresh frozen plasma-red blood cell ratio was 1:2. After PPP/EF, 10 patients (13%) underwent angioembolization with a documented blush; time to angioembolization was 10.6 ± 2.4 hours (range 1 to 38 hours). Mortality for all pelvic fractures was 8%, with 21% mortality in this high-risk group. There were no deaths due to acute hemorrhage. CONCLUSIONS: PPP/EF was effective in controlling hemorrhage from unstable pelvic fractures. None of these high-risk patients died due to pelvic bleeding. Secondary angioembolization was needed in a minority, permitting selective use of this resource-demanding intervention. Additionally, PPP/EF temporizes arterial hemorrhage, providing valuable transfer time for facilities without angiography. With other urgent operative interventions required in >85% of patients, combining these procedures with PPP/EF for operative pelvic hemorrhage control appears to optimize patient care.
Authors: Clay Cothren Burlew; Ernest E Moore; Philip F Stahel; Andrea E Geddes; Amy E Wagenaar; Fredric M Pieracci; Charles J Fox; Eric M Campion; Jeffrey L Johnson; Cyril Mauffrey Journal: J Trauma Acute Care Surg Date: 2017-02 Impact factor: 3.313
Authors: Ahmed El Muntasar; Ethan Toner; Oddai A Alkhazaaleh; Danaradja Arumugam; Nikhil Shah; Shahab Hajibandeh; Shahin Hajibandeh Journal: World J Emerg Med Date: 2018
Authors: Sebastian Weckbach; Michael A Flierl; Michael Blei; Clay Cothren Burlew; Ernest E Moore; Philip F Stahel Journal: Scand J Trauma Resusc Emerg Med Date: 2011-10-25 Impact factor: 2.953
Authors: Lucas S Marchand; Aresh Sepehri; Zachary D Hannan; Syed M R Zaidi; Abdulai T Bangura; Jonathan J Morrison; Theodore T Manson; Gerard P Slobogean; Nathan N O'Hara; Robert V O'Toole Journal: J Orthop Trauma Date: 2022-02-01 Impact factor: 2.512