Preperitonal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures: A Paradigm Shift

Cothren, Clay C.; Osborn, Patrick M.; Moore, Ernest E.; Morgan, Steven J.; Johnson, Jeffrey L.; Smith, Wade R.

doi:10.1097/ta.0b013e31803c7632

Cited by 291 publications

(243 citation statements)

References 25 publications

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“…The PPP technique has one limitation, in that it cannot control arterial bleeding sufficiently. Therefore, in general, a patient with ongoing bleeding after pelvic packing necessitates an angiography [5]. Surgical ligation of the internal iliac artery may be a reasonable option for a patient with profound pelvic bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…However, PPP was introduced as an alternative option [5]. Pelvic packing was first described 23 years ago in European literature [6].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, PPP has been regarded as a useful option for pelvic hemorrhage in the United States, even though as a standard option, it remains controversial [2]. PPP aims to compress venous and bone bleeding by the tamponade effect [5]. Therefore, the bony structure of the pelvis must be intact to achieve the tamponade effect.…”

Section: Discussionmentioning

confidence: 99%

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Internal Iliac Artery Ligation with Pad Packing for Hemodynamic Unstable Open Comminuted Sacral Fracture

Kim

Park

et al. 2017

Journal of Trauma and Injury

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A 52-year-old man experienced blunt trauma upon falling from a height of 40 m while trying to repair the elevator. The patient's systolic blood pressure and hemoglobin levels were 60 mmHg and 7.0 g/dL, respectively, upon admission. A large volume of bloody discharge was observed in the open wound of the perianal area and sacrum. A computed tomography scan revealed an open comminuted sacral fracture with multiple contrast blushes. He underwent emergency laparotomy. Both internal iliac artery ligations were performed to control bleeding from the pelvis. Protective sigmoid loop colostomy was performed because of massive injury to the anal sphincters and pelvis. Pad packing was performed for a sacral open wound and perineal wound at the prone position. After resuscitation of massive transfusion, he underwent the second operation 2 days after the first operation. The pad was removed and the perineal and sacral open wounds were closed. After the damage-control surgery, he recovered safely. In this case, the hemodynamically unstable, open comminuted sacral fracture was treated safely by internal iliac artery ligation with pad packing.

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Section: Discussionmentioning

confidence: 99%

“…However, PPP was introduced as an alternative option [5]. Pelvic packing was first described 23 years ago in European literature [6].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Internal Iliac Artery Ligation with Pad Packing for Hemodynamic Unstable Open Comminuted Sacral Fracture

Kim

Park

et al. 2017

Journal of Trauma and Injury

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“…Similarly, Osborn and colleagues 23 noted a reduction to hemorrhage control within 45 minutes for pelvic packing compared with 130 minutes for angiography. Finally, although door to needle times are inadequately discussed, Cothren and colleagues 24 also advocate routine peritoneal pelvic packing with a combined operative and subsequent angiography time of 164 minutes. It is interesting to note that although these delays appear much shorter than our overall pelvic fracture door to needle times (median 278 min), the mean time for patients with pelvic fractures and concurrent hypotension that was not responsive to resuscitation in our audit was only 41 min.…”

Section: Discussionmentioning

confidence: 99%

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Smith

Ouellet

Niven

et al. 2013

CJS

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RESEARCH • RECHERCHETimeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?Background: Modern trauma care relies heavily on nonoperative, emergent percutaneous procedures, particularly in patients with splenic, pelvic and hepatic injuries. Unfortunately, specific quality measures (e.g., arrival to angiography times) have not been widely discussed. Our objective was to evaluate the time interval from arrival to initiation of emergent percutaneous procedures in severely injured patients.Methods: All severely injured trauma patients (injury severity score [ISS] > 12) presenting to a level 1 trauma centre (2007)(2008)(2009)(2010) were analyzed with standard statistical methodology.Results: Among 60 severely injured patients (mean ISS 31, hypotension 18%, mortality 12%), the median time interval to the initiation of an angiographic procedure was 270 minutes. Of the procedures performed, 85% were therapeutic embolizations and 15% were diagnostic procedures. Splenic (median time 243 min, range 32-801 min) and pelvic (median time 278 min, range 153-466 min) embolizations accounted for 43% and 25% of procedures, respectively. The median embolization procedure duration for the spleen was 28 (range 15-153) minutes compared with 59 (range 34-171) minutes for the pelvis. Nearly 22% of patients required both an emergent percutaneous and subsequent operative procedure. Percutaneous therapy typically preceded open operative explorations. Conclusion:The time interval from arrival at the trauma centre to emergent percutaneous procedures varied widely. Improved processes emphasizing patient transition from the trauma bay to the angiography suite are essential. Discussion regarding the appropriate time to angiography is needed so this marker can be used as a quality outcome measure for all level 1 trauma centres. Contexte :De nos jours, en traumatologie, les soins reposent largement sur des interventions non chirurgicales percutanées d'extrême urgence, particulièrement chez les patients blessés à la rate, au bassin et au foie. Malheureusement, les indices de qualité spé-cifiques (p. ex., temps écoulé entre l'arrivée et l'angiographie) n'ont pas fait l'objet de discussions approfondies. Notre objectif était de mesurer le temps écoulé entre l'arrivée et l'instauration des interventions percutanées d'extrême urgence chez les grands blessés. Méthodes

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“…Control of bleeding in the early clinical pathway of these traumatised patients is therefore of paramount importance. Temporary stabilisation of the fractured pelvis with binders [1,[4][5][6] or external fixation devices (external fixator, C-clamp) combined with pelvic packing and/or angiography have been used with variable results [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

Karadimas

Nicolson

Kakagia

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the relation between pelvic fracture patterns and the angiographic findings, and to assess the effectiveness of the embolisation. Methods This retrospective study, included patients with pelvic fractures and angiographic evaluation. Demographics, Injury Severity Score (ISS), associated injuries, embolisation time, blood units needed, method of treatment and complications were recorded and analysed. Fractures were classified according to the Burgess system. Results Between 1998 and 2008, 34 patients with pelvic fractures underwent angiographic investigation. Twenty six were males. The mean age was 41 years. Twenty-seven were motor vehicle accidents and seven were falls. There were 11 anterior posterior (APC) fractures, 12 lateral compression (LC), eight vertical shear (VS) patterns and three with combined mechanical injuries. The median ISS was 33.1 (range 5-66). From the 34 who underwent angiography, 29 had positive vascular extravasations. From them, 21 had embolisation alone, two had vascular repair and embolisation, five required vascular repair alone and one patient died while being prepared for embolisation. Five cases were re-embolised. The findings suggested that AP fractures have a higher tendency to bleeding compared with LC fractures. Both had a higher chance of blood loss compared to VS and complex fracture patterns. We reported 57 additional injuries and 65 fractures. The complications were: one non lethal pulmonary embolism, one renal failure, one liver failure, one systemic infection, two deep infections and two psychological disorientations. Seven patients died in hospital. Conclusion Control of pelvic fracture bleeding is based on the multidisciplinary approach mainly related to hospital facilities and medical personnel's awareness. The morphology of the fracture did not have a predictive value of the vascular lesion and the respective bleeding.

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Preperitonal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures: A Paradigm Shift

Abstract: PPP is a rapid method for controlling pelvic fracture-related hemorrhage that can supplant the need for emergent angiography. There is a significant reduction in blood product transfusion after PPP, and this approach appears to reduce mortality in this select high-risk group of patients.

Cited by 291 publications

References 25 publications

Internal Iliac Artery Ligation with Pad Packing for Hemodynamic Unstable Open Comminuted Sacral Fracture

Internal Iliac Artery Ligation with Pad Packing for Hemodynamic Unstable Open Comminuted Sacral Fracture

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

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