Emergency Management of Pelvic Bleeding
Pelvic trauma continues to have a high mortality rate despite damage control techniques for bleeding control. The aim of our study was to evaluate how Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) impact the efficacy on mortality and hemo...
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doaj-ffc4048de1cf433998b99ee62008e3b42021-01-02T00:02:16ZengMDPI AGJournal of Clinical Medicine2077-03832021-01-011012912910.3390/jcm10010129Emergency Management of Pelvic BleedingSimone Frassini0Shailvi Gupta1Stefano Granieri2Stefania Cimbanassi3Fabrizio Sammartano4Thomas M. Scalea5Osvaldo Chiara6General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, ItalyAdams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St, Baltimore, MD 21201, USAGeneral Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, ItalyGeneral Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, ItalyGeneral Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, ItalyAdams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St, Baltimore, MD 21201, USAGeneral Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, ItalyPelvic trauma continues to have a high mortality rate despite damage control techniques for bleeding control. The aim of our study was to evaluate how Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) impact the efficacy on mortality and hemodynamic impact. We retrospectively evaluated patients who sustained blunt trauma, pelvic fracture and hemodynamic instability from 2002 to 2018. We excluded a concomitant severe brain injury, resuscitative thoracotomy, penetrating trauma and age below 14 years old. The study population was divided in EPP and REBOA Zone III group. Propensity score matching was used to adjust baseline differences and then a one-to-one matched analysis was performed. We selected 83 patients, 10 for group: survival rate was higher in EPP group, but not significantly in each outcome we analyzed (24 h, 7 day, overall). EPP had a significant increase in main arterial pressure after procedure (+20.13 mmHg, <i>p</i> < 0.001), but this was not as great as the improvement seen in the REBOA group (+45.10 mmHg, <i>p</i> < 0.001). EPP and REBOA are effective and improve hemodynamic status: both are reasonable first steps in a multidisciplinary management. Zone I REBOA may be useful in patients ‘in extremis condition’ with multiple sites of torso hemorrhage, particularly those in extremis.https://www.mdpi.com/2077-0383/10/1/129pelvic traumapackingextra-peritoneal packingREBOAresuscitationbleeding |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Simone Frassini Shailvi Gupta Stefano Granieri Stefania Cimbanassi Fabrizio Sammartano Thomas M. Scalea Osvaldo Chiara |
spellingShingle |
Simone Frassini Shailvi Gupta Stefano Granieri Stefania Cimbanassi Fabrizio Sammartano Thomas M. Scalea Osvaldo Chiara Emergency Management of Pelvic Bleeding Journal of Clinical Medicine pelvic trauma packing extra-peritoneal packing REBOA resuscitation bleeding |
author_facet |
Simone Frassini Shailvi Gupta Stefano Granieri Stefania Cimbanassi Fabrizio Sammartano Thomas M. Scalea Osvaldo Chiara |
author_sort |
Simone Frassini |
title |
Emergency Management of Pelvic Bleeding |
title_short |
Emergency Management of Pelvic Bleeding |
title_full |
Emergency Management of Pelvic Bleeding |
title_fullStr |
Emergency Management of Pelvic Bleeding |
title_full_unstemmed |
Emergency Management of Pelvic Bleeding |
title_sort |
emergency management of pelvic bleeding |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-01-01 |
description |
Pelvic trauma continues to have a high mortality rate despite damage control techniques for bleeding control. The aim of our study was to evaluate how Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) impact the efficacy on mortality and hemodynamic impact. We retrospectively evaluated patients who sustained blunt trauma, pelvic fracture and hemodynamic instability from 2002 to 2018. We excluded a concomitant severe brain injury, resuscitative thoracotomy, penetrating trauma and age below 14 years old. The study population was divided in EPP and REBOA Zone III group. Propensity score matching was used to adjust baseline differences and then a one-to-one matched analysis was performed. We selected 83 patients, 10 for group: survival rate was higher in EPP group, but not significantly in each outcome we analyzed (24 h, 7 day, overall). EPP had a significant increase in main arterial pressure after procedure (+20.13 mmHg, <i>p</i> < 0.001), but this was not as great as the improvement seen in the REBOA group (+45.10 mmHg, <i>p</i> < 0.001). EPP and REBOA are effective and improve hemodynamic status: both are reasonable first steps in a multidisciplinary management. Zone I REBOA may be useful in patients ‘in extremis condition’ with multiple sites of torso hemorrhage, particularly those in extremis. |
topic |
pelvic trauma packing extra-peritoneal packing REBOA resuscitation bleeding |
url |
https://www.mdpi.com/2077-0383/10/1/129 |
work_keys_str_mv |
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