Benefits of early application of pelvic circumferential compression device to reduce bleeding in pelvic fractures

Abstract

Background To study of efficacy of early pelvic circumferential compression device using in patients with suspected pelvic trauma, compared with conventional stepwise approach. Methods Traumatic injury and at least one of the following criteria are required for inclusion: loss of consciousness or a Glasgow coma score (GCS) of less than 13; systolic blood pressure less than 90 mmHg; falling from more than 6 m; injury to several important organs; and a positive pelvic compression test. Patients who satisfied the inclusion criteria for the experimental group were given an early application of a commercial pelvic sling beginning in July 2019. The control group consisted of cases who got the device after clinical or radiological confirmation of a pelvic fracture in the previous year. Gender, age, mechanism of injury, GCS, hospital stay, amount of packed red blood cell transfusion, hematocrit in emergency room, and hematocrit 24 h after application of pelvic binder were all assessed and compared. Results The study had a total of 30 participants, with 15 in each group. The number of packed red blood cell transfusions in the early pelvic binder group (0.80 ± 1.42) is considerably lower than in the control group (2.4 ± 2.32) (P = 0.008), although the hematocrit change is not statistically different between the groups (2.1 VS 0.7) (P = 0.191). The time it took to install a pelvic binder was considerably shorter in the early pelvic binder group (16.40 ± 5.45) than in the control group (40.40 ± 13.64) (P = 0.001). There were no problems associated to soft tissue and skin necrosis in either group of patients. Conclusions The use of the PCCD for 24 h prior to clinical and radiographic confirmation has significantly reduced the rate of packed red blood cell transfusion in any pelvic fracture patient without device-related complications. Trial registration The study was entered into the Thai Clinical Trials Registry (TCTR20210809007).

Imposter or knight in shining armor? Pelvic circumferential compression devices (PCCD) for severe pelvic injuries in patients with multiple trauma: a trauma-registry analysis

“…Historic cases in whom PCCD was applied after clinical or radiological confirmation of a pelvic fracture served as control [ 18 ]. Rungsinaporn et al who also assessed blood saving effects from early PCCD application in the ER, showed that PCCD on patients suspicious of pelvic injury lead to considerably lower number of pRBC transfusions in the early PCCD group compared to historic controls where PCCD was only applied after radiological confirmation of the pelvic fracture [ 19 ]. This advantage could be due to a time difference of approx.…”

Damage-control orthopedics or early total care: What you need to know

“…30 External mechanical compression devices are being applied empirically in the prehospital environment and trauma bay successfully, reducing the number of blood transfusions necessary during resuscitation without increasing the risk of complication. 31,32 If patients remain hemodynamically unstable despite EMC application, other strategies for controlling hemorrhage should be used early. These include angiography and embolization, extraperitoneal pelvic packing, [33][34][35] and/or application of external fixation devices.…”

“…Given that the EMC provides circumferential compression, it may be better than an anteriorly based external fixator or a C-clamp in managing pelvic hemorrhage, which can only provide compression in a single plane 30 . External mechanical compression devices are being applied empirically in the prehospital environment and trauma bay successfully, reducing the number of blood transfusions necessary during resuscitation without increasing the risk of complication 31,32 …”

Angioembolisation for arterial haemorrhage related to pelvic ring injury

“…1 Measures, such as pelvic binders, have been proven to reduce rate of blood transfusion and mortality rate. 2,3 Another technique, resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown promise although knowledge about its practice patterns are limited. 4,5 Angioembolisation for the management of pelvic haemorrhage was performed as early as 1972.…”

“…Over the years, there have been vast improvements in hospital protocols for the management of major pelvic trauma, with angiography fast becoming a vital component 1 . Measures, such as pelvic binders, have been proven to reduce rate of blood transfusion and mortality rate 2,3 . Another technique, resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown promise although knowledge about its practice patterns are limited 4,5 .…”