Preperitoneal pelvic packing: Technique and outcomes

Filiberto, Dina M.; Fox, Adam D.

doi:10.1016/j.ijsu.2016.05.072

Cited by 40 publications

(33 citation statements)

References 16 publications

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“…The “trigger” to perform this technique is the persistent hemodynamic instability of the patient despite two units of red blood cells transfusion during the initial resuscitation ( 137 ). Other proposed indications were unstable patients with pelvic hematoma diagnosed on focused assessment with sonography in trauma exam and in cases of unavailable angiographic embolization in some centers ( 138 ). The survival rate of patients with iliac venous injuries ranges between 65 and 95% ( 1 , 25 , 93 , 107 , 117 , 134 ).…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma

et al. 2018

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The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.

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Section: Diagnostic Evaluationmentioning

confidence: 99%

Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma

et al. 2018

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“…[1][2][3][4][17][18][19] The late mortality of unstable pelvic injury caused by multiple organ failure owing to intractable hemodynamic shock. 14,[18][19][20] The main bleeding source was not the rupture artery, but the exsanguinous and the consuming of the coagulopathy components were. 14,20 The low thrombocyte count in this study did not have any association with the hematologic problem.…”

Section: Discussionmentioning

confidence: 99%

Factors that influence the survival of unstable pelvic fracture in the acute phase

2018

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Background:The fatality rate of unstable pelvic fracture is still high (20-50%) due to acute phase hemorrhage or late multiple organ failure. The assurance for 100% survival in acute phase had been reported if the emergency room team have the right technique, right timing, and right protocol. The aim of this study was to evaluate and to date factors that influence the nonsurvival unstable pelvic fracture within 2x24 hours.Methods: This retrospective study was conducted in emergency unit of Dr. Soetomo General Hospital Surabaya during 2012-2016 for unstable pelvic fracture with unstable hemodynamic, without concomitant head or thoracic injury and admitted within 4 hours after the incident. All patients were handled according to the protocol for resuscitation and C-clamp insertion immediately. X-ray was taken after the insertion to check the C-clamp position and to confirm the diagnosis. The 2x24-hour data were taken whether the patient survive or not survive, including mean arterial pressure (MAP) pre-and post, heart rate (HR) pre-and post, and initial hemoglobin and platelet count. Data were analyzed with independent t-test and multiple regression analysis.Results: Twenty two patients were recorded as the inclusive criteria, separated into 17 survivors and 5 non-survivors. They were comprised of 14 males and 8 female patients, with an average of 31.9±15.3 years old. The MAP post, HR pre-and post, and platelet count were significantly different. The factor that influenced the survival within 2x24 hours was the MAP post C-clamp (>70 mmHg) (p<0.05). Conclusion:The acute phase 2x24-hour outcome after C-clamp insertion and resuscitation was significantly influenced by MAP post C-clamp and resuscitation.

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“…The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) is also a controversial temporising measure to manage haemorrhagic shock prior to gaining definitive haemostasis which requires access to the operating theatre and interventional radiology (which can sometimes take time to activate) ( 32 , 39 ). Temporary fracture stabilisation, angioembolisation, and extraperitoneal packing (EPP) are used to manage the haemorrhagic phase for patients with pelvic ring fractures ( 22 , 32 – 34 , 40 – 42 ), however the technique and the order in which they are applied is determined by the surgeon, resources, and institution. In addition to these management options soft tissue injuries to the perineum, genitals, bladder, and bowel need to be considered and managed in patients with open pelvic fractures, complicating the treatment, and decision making in this group of patients.…”

Section: Managementmentioning

confidence: 99%

The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures

Watkins

Hsu

2020

Front. Surg.

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Management of haemodynamically unstable pelvic ring injuries has been simplified into treatment algorithms to streamline care and emergent decision making in order to improve patient outcomes whilst decreasing mortality and morbidity. Pelvic ring injuries are most commonly a result of high-velocity and energy forces that exert trauma to the pelvic bones causing not only damage to the bone but the surrounding soft-tissue, organs, and other structures and are usually accompanied by injuries to other parts of the body resulting in a polytraumatised patient. Open pelvic fractures are a rare subset of pelvic ring fractures that are on the more severe end of the pelvic fracture continuum and usually produce uncontrolled haemorrhage from fractured bone, retroperitoneal haematomas, intraabdominal bleeding from bowel injury, soft tissue injuries to the anus, perineum, and genitals, fractures of the pelvic bones, causing bleeding from cancellous bone, venous, and arterial injuries combined with bleeding from concomitant injuries. This is a very complex and challenging clinical situation and timely and appropriate decisions and action are paramount for a positive outcome. Consequently, open pelvic fractures have an extremely high rate of mortality and morbidity and outcomes remain poor, despite evidence-based improvements in treatment, knowledge, and identification of haemorrhage; in the pre-hospital, critical care, and operative settings. In the future utilisation of haemostatic drugs, dressings, devices, and procedures may aid in the time to haemorrhage control.

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Preperitoneal pelvic packing: Technique and outcomes

Cited by 40 publications

References 16 publications

Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma

Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma

Factors that influence the survival of unstable pelvic fracture in the acute phase

The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures

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