Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control

Abstract

Major pelvic hemorrhage remains a considerable challenge of modern trauma care associated with mortality in over a third of patients. Efforts to improve outcomes demand continued research into the optimal employment of both traditional and newer hemostatic adjuncts across the full spectrum of emergent care environments. The purpose of this review is to provide a concise description of the rationale for and effective use of currently available adjuncts for the control of pelvic hemorrhage. In addition, the challenges of defining the optimal order and algorithm for employment of these adjuncts will be outlined.

Developing a National Trauma Research Action Plan: Results from the acute resuscitation, initial patient evaluation, imaging, and management research gap Delphi survey

“…Pelvic fracture management requires a multidisciplinary team to both control hemorrhage and stabilize the fractured pelvic ring. While several hemorrhage control interventions can be beneficial, including angioembolization, preperitoneal pelvic packing, and pelvic external fixator placement, there remains controversy over the optimal management strategies for these severely injured patients 13,30–33 . The use of resuscitative endovascular balloon occlusion of the aorta was identified as another high-priority research area, as these devices are increasingly used to temporize pelvic hemorrhage as a bridge to either surgery or angiographic intervention.…”

“…While several hemorrhage control interventions can be beneficial, including angioembolization, preperitoneal pelvic packing, and pelvic external fixator placement, there remains controversy over the optimal management strategies for these severely injured patients. 13,[30][31][32][33] The use of resuscitative endovascular balloon occlusion of the aorta was identified as another high-priority research area, as these devices are increasingly used to temporize pelvic hemorrhage as a bridge to either surgery or angiographic intervention. However, identifying optimal patient selection and integrating resuscitative endovascular balloon occlusion of the aorta with other hemorrhage control interventions require multicenter, prospective studies.…”

“…For example, the mortality rate of patients with severe pelvic fracture has been relatively unchanged over the past 30 years. 13,14 In addition, mortality for patients requiring emergent trauma laparotomy has also not improved over the past two decades, suggesting that further advances are required to achieve the goals of the NASEM report. 15 When research funding is directed toward highly relevant research questions, advances are made, and patient outcomes often improve.…”

“…Despite these advances, outcomes have not improved significantly in decades for some injury patterns. For example, the mortality rate of patients with severe pelvic fracture has been relatively unchanged over the past 30 years 13,14 . In addition, mortality for patients requiring emergent trauma laparotomy has also not improved over the past two decades, suggesting that further advances are required to achieve the goals of the NASEM report 15 …”

Adopting a culture of remote damage control resuscitation in the military: Insights from the Israel defense forces decade of experience

“…In addition, their use among infantry and special forces units may be limited because of their dimensions and weight. Accordingly, we introduced a new CPG 30 for the treatment of orthopedic injuries in the prehospital setting, focusing on the use of pelvic binders in the primary survey, 31,32 and the use of leg traction splints (as part of the secondary survey) when a femoral fracture is suspected, without delaying evacuation. These guidelines, focusing on the specific measures aimed at reducing bleeding from orthopedic injuries, have been incorporated into courses for ALS providers and Role 2 medical teams.…”