nach oben

European Journal of Trauma and Emergency Surgery

Erschienen in:

06.04.2019 | Original Article

Prospective validation of a new protocol with preperitoneal pelvic packing as the mainstay for the treatment of hemodynamically unstable pelvic trauma: a 5-year experience

verfasst von: Stefano Magnone, Niccolò Allievi, Marco Ceresoli, Federico Coccolini, Michele Pisano, Luca Ansaloni

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 2/2021

Einloggen, um Zugang zu erhalten

Abstract

Purposes

Hemodynamically unstable pelvic trauma has been a significant challenge even in most experienced Trauma Centres. In 2011 preperitoneal pelvic packing (PPP) was introduced in our Hospital as the first manoeuvre. This study aims to review overall mortality at 24 h from arrival in the emergency department.

Methods

A retrospective review of our prospective database was performed considering patients with systolic blood pressure (SBP) < 90 mmHg or with the need for more than 2 Units of packed red blood cells (PRBC) on admission in the emergency department, (ED) and a pelvic fracture. Values were expressed as a median and interquartile range. Continuous variables were compared with the Mann–Whitney test.

Results

Between September 2011 and December 2016, we treated 30 patients. Median age was 51 years (40–65) and Injury Severity Score 36 (34–42). SBP in the ED was 90 (67–99), heart rate was 115 (90–130), Base Excess − 8 (− 11.5/− 4.8), pH 7.23 (7.20–7.28). Median PRBC requirements during the first 24 h (from admission) were 13 Units (8–18.8). Time to emergency treatment was 63 min (51–113). 17 patients (56.6%) underwent angiography after PPP. Overall 24 h mortality was 30%. A comparison between survivors and non-survivors showed no statistically significant differences between groups.

Conclusions

In our experience, PPP resulted to be quick to perform and effective. No death occurred from direct pelvic bleeding.

Jang JY, Shim H, Jung PY, Kim S, Bae KS. Preperitoneal pelvic packing inpatients with hemodynamic instability due to severe pelvic fracture: early experience in a Korean trauma center. Scand J Trauma Resusc Emerg Med. 2016;24:3.PubMedPubMedCentral

Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002;195:1–10.PubMed

Starr AJ, Griffin DR, Reinert CM, Frawley WH, Walker J, Whitlock SN, et al. Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma. 2002;16:553–61.PubMed

Verbeek DO, Sugrue M, Balogh Z, Cass D, Civil I, Harris I, et al. Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg. 2008;32:1874–82.PubMed

Sathy AK, Starr AJ, Smith WR, Elliott A, Agudelo J, Reinert CM, et al. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Jt Surg Am. 2009;91(12):2803–10.

Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, et al. Eastern Association for the Surgery of Trauma practice management guidelines for haemorrhage in pelvic fracture-update and systematic review. J Trauma. 2011;71(6):1850–68.PubMed

Burlew CC, Moore EE, Smith WR, Johnson JL, Biffl WL, Barnett CC, et al. Preperitoneal pelvic packing/external fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures. J Am Coll Surg. 2011;212(4):628–35 (discussion 635–637).PubMed

Burlew CC, Moore EE, Stahel PF, Geddes AE, Wagenaar AE, Pieracci FM, et al. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma Acute Care Surg. 2017;82(2):233–42.PubMedPubMedCentral

Davis JW, Moore FA, McIntyre RC, Cocanour CS, Moore EE, West MA. Western Trauma Association critical decisions in trauma: management of pelvic fracture with hemodynamic instability. J Trauma. 2008;65:1012–5.PubMed

10.

Margolies MN, Ring EJ, Waltman AC, Kerr WS, Baum S. Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med. 1972;287:317–21.PubMed

11.

Matalon TS, Athanasoulis CA, Margolies MN, Waltman AC, Novelline RA, Greenfield AJ, et al. Hemorrhage with pelvic fractures: efficacy of transcatheter embolization. Am J Roentgenol. 1979;133:859–64.

12.

Huittinen VM, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery. 1973;73:454–62.PubMed

13.

Osborn PM, Smith WR, Moore EE, Cothren CC, Morgan SJ, Williams AE, et al. Direct retroperitoneal pelvic packing versus pelvic angiography: a comparison of two management protocols for haemodynamically unstable pelvic fractures. Injury. 2009;40:54–60.PubMed

14.

Li Q, Dong J, Yang Y, Wang G, Wang Y, Liu P, et al. Retroperitoneal packing or angioembolization for haemorrhage control of pelvic fractures—quasi-randomized clinical trial of 56 haemodynamically unstable patients with Injury Severity Score ≥ 33. Injury. 2016;47(2):395–401.PubMed

15.

Papakostidis C, Giannoudis PV. Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 2009;40(Supplement 4):S53–61.PubMed

16.

Morozumi J, Homma H, Ohta S, Noda M, Oda J, Mishima S, et al. Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage with hemodynamic instability. J Trauma. 2010;68:90–5.PubMed

17.

Panetta T, Sclafani SJ, Goldstein AS, Phillips TF, Shaftan GW. Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma. 1985;25:1021–9.PubMed

18.

Piotin M, Herbreteau D, Guichard JP, Houdart E, Reizine D, Aymard A, et al. Percutaneous transcatheter embolization in multiply injured patients with pelvic ring disruption associated with severe hemorrhage and coagulopathy. Injury. 1995;26:677–80.PubMed

19.

Tesoriero RB, Bruns BR, Narayan M, Dubose J, Guliani SS, Brenner ML, et al. Angiographic embolization for hemorrhage following pelvic fracture: is it “time” for a paradigm shift? J Trauma Acute Care Surg. 2017;82(1):18–26.PubMed

20.

Pohlemann T, Gansslen A, Bosch U, Tscherne U. The technique of packing for control of hemorrhage in complex pelvic fractures. Tech Orthop. 1994;9:267–70.

21.

Ertel W, Keel M, Eid K, Platz A, Trentz O. Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma. 2001;15:468–74.PubMed

22.

Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;18(12):5.

23.

Osborn PM, Smith WR, Moore EE, Cothren CC, Morgan SJ, Williams AE, et al. Retroperitoneal packing as a resuscitation technique for hemodynamically unstable pelvic fractures: report of two cases and description of technique. J Trauma. 2005;59:1510–4.PubMed

24.

Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitoneal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma. 2007;62:834–42.PubMed

25.

Magnone S, Coccolini F, Manfredi R, Piazzalunga D, Agazzi R, Arici C, et al. Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology-Section of Vascular and Interventional Radiology-and the World Society of Emergency Surgery). World J Emerg Surg. 2014;9(1):18.PubMedPubMedCentral

26.

Pascarella R, Del Torto M, Politano R, Commessatti M, Fantasia R, Maresca A. Critical review of pelvic fractures associated with external iliac artery lesion: a series of six cases. Injury. 2014;45(2):374–8.PubMed

27.

Lindahl J, Handolin L, Söderlund T, Porras M, Hirvensalo E. Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related factors. Eur J Trauma Emerg Surg. 2013;39(1):57–63.PubMed

28.

Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):S1–133.PubMed

29.

Papakostidis C, Giannoudis PV. Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 2009;40(Suppl 4):S53–61.PubMed

30.

Schwartz DA, Medina M, Cotton BA, Rahbar E, Wade CE, Cohen AM, et al. Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. J Trauma Acute Care Surg. 2014;76(1):134–9.PubMed

31.

Hauschild O, Aghayev E, von Heyden J, Strohm PC, Culemann U, Pohlemann T, et al. Angioembolization for pelvic hemorrhage control: results from the German pelvic injury register. J Trauma Acute Care Surg. 2012;73(3):679–84.PubMed

32.

Fang JF, Shih LY, Wong YC, Lin BC, Hsu YP. Repeat transcatheter arterial embolization for the management of pelvic arterial hemorrhage. J Trauma. 2009;66(2):429–35.PubMed

33.

Tötterman A, Dormagen JB, Madsen JE, Kløw NE, Skaga NO, Røise O. A protocol for angiographic embolization in exsanguinating pelvic trauma: a report on 31 patients. Acta Orthop. 2006;77(3):462–8.PubMed

34.

Magnone S, Allegri A, Belotti E, Castelli CC, Ceresoli M, Coccolini F, et al. Impact of ATLS guidelines, trauma team introduction, and 24-hour mortality due to severe trauma in a busy, metropolitan Italian hospital: a case control study. Ulus Travma Acil Cerrahi Derg. 2016;22(3):242–6.PubMed

35.

Tiel Groenestege-Kreb D, van Maarseveen O, Leenen L. Trauma team. Br J Anaesth. 2014;113(2):258–65.PubMed

36.

Lustenberger T, Meier C, Benninger E, Lenzlinger PM, Keel MJ. C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption. J Emerg Trauma Shock. 2011;4(4):477–82.PubMedPubMedCentral

37.

Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 2013;99(2):175–82.PubMed

38.

Gansslen A, Hildebrand F, Pohlemann T. Management of hemodynamic unstable patients “in extremis” with pelvic ring fractures. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2012;79:193–202.PubMed

39.

Gaarder C, Naess PA, Frischknecht Christensen E, Hakala P, Handolin L, et al. Scandinavian guidelines “The massively bleeding patient”. Scand J Surg. 2008;97:15e36.

40.

Tosounidis TI, Giannoudis PV. Pelvic fractures presenting with haemodynamic instability: treatment options and outcomes. Surgeon. 2013;11(6):344–51.PubMed

41.

Ganz R, Krushell RJ, Jakob RP, Küffer J. The antishock pelvic clamp. Clin Orthop. 1991;267:71–8.

42.

Mauffrey C, Cuellar DO 3rd, Pieracci F, Hak DJ, Hammerberg EM, Stahel PF, et al. Strategies for the management of haemorrhage following pelvic fractures and associated trauma-induced coagulopathy. Bone Jt J. 2014;96-B(9):1143–54.

43.

Tonetti J. Management of recent unstable fractures of the pelvic ring. An update conference supported by the Club Bassin Cotyle. (Pelvis-Acetabulum Club). Orthop Traumatol Surg Res. 2013;99(1 Suppl):S77–86.PubMed

44.

Thorson CM, Ryan ML, Otero CA, Vu T, Borja MJ, Jose J, et al. Operating room or angiography suite for hemodynamically unstable pelvic fractures? J Trauma Acute Care Surg. 2012;72(2):364–70.PubMed

45.

Nunn T, Cosker TD, Bose D, Pallister I. Immediate application of improvised pelvic binder as first step in extended resuscitation from life-threatening hypovolemic shock in conscious patients with unstable pelvic injuries. Injury. 2007;38(1):125–8.PubMed

46.

Knops SP, Van Lieshout EM, Spanjersberg WR, Patka P, Schipper IB. Randomized clinical trial comparing pressure characteristics of pelvic circumferential compression devices in healthy volunteers. Injury. 2011;42(10):1020–6.PubMed

47.

Bonner TJ, Eardley WG, Newell N, Masouros S, Matthews JJ, Gibb I, et al. Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. J Bone Jt Surg Br. 2011;93(11):1524–8.

48.

Tan EC, van Stigt SF, van Vugt AB. Effect of a new pelvic stabilizer (T-POD^®) on reduction of pelvic volume and hemodynamic stability in unstable pelvic fractures. Injury. 2010;41(12):1239–43.PubMed

49.

Totterman A, Madsen JE, Skaga NO, Roise O. Extraperitoneal pelvic packing: a salvage procedure to control massive traumatic pelvic hemorrhage. J Trauma. 2007;62:843e52.

50.

Gaski IA, Barckman J, Naess PA, Skaga NO, Madsen JE, Kløw NE, et al. Reduced need for extraperitoneal pelvic packing for severe pelvic fractures is associated with improved resuscitation strategies. J Trauma Acute Care Surg. 2016;81(4):644–51.PubMed

51.

Finan MA, Fiorica JV, Hoffman MS, Barton DP, Gleeson N, Roberts WS, et al. Massive pelvic hemorrhage during gynecologic cancer surgery: “pack and go back”. Gynecol Oncol. 1996;62(3):390–5.PubMed

52.

Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, et al. Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: a content analysis and expert appropriateness rating study. J Trauma Acute Care Surg. 2015;79(4):568–79.PubMed

53.

Lustenberger T, Wutzler S, Störmann P, Laurer H, Marzi I. The role of angio-embolization in the acute treatment concept of severe pelvic ring injuries. Injury. 2015;46(Suppl 4):S33–8.PubMed

54.

Suzuki T, Smith WR, Moore EE. Pelvic packing or angiography: competitive or complementary? Injury. 2009;40:343–53.PubMed

55.

Pieper A, Thony F, Brun J, Rodière M, Boussat B, Arvieux C, Tonetti J, Payen JF, Bouzat P. Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage: a 20-year experience in a Level I trauma center. J Trauma Acute Care Surg. 2018;84(3):449–53.PubMed

56.

Skitch S, Engels PT. Acute management of the traumatically injured pelvis. Emerg Med Clin N Am. 2018;36(1):161–79.

57.

Magnone S, Ceresoli M, Coccolini F, Nita GE, Rizzi L, Merli C, Colombi R, Piazzalunga D, Valetti TM, Castelli CC, Ansaloni L. Haemodynamically unstable pelvic trauma: initial validation of a dedicated protocol by a retrospective cohort study with historical controls. S Afr J Surg. 2018;56(4):33–9.

Titel: Prospective validation of a new protocol with preperitoneal pelvic packing as the mainstay for the treatment of hemodynamically unstable pelvic trauma: a 5-year experience
verfasst von: Stefano Magnone
Niccolò Allievi
Marco Ceresoli
Federico Coccolini
Michele Pisano
Luca Ansaloni
Publikationsdatum: 06.04.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 2/2021
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-019-01115-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

25.04.2024 | Hypertonie | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Prospective validation of a new protocol with preperitoneal pelvic packing as the mainstay for the treatment of hemodynamically unstable pelvic trauma: a 5-year experience

Abstract

Purposes

Methods

Results

Conclusions

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Purposes

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2021

Closed reduction techniques for acute anterior shoulder dislocation: a systematic review and meta-analysis

Intake of NOAC is associated with hematoma expansion of intracerebral hematomas after traumatic brain injury

Effects of negative-pressure therapy with and without ropivacaine instillation in the early evolution of severe peritonitis in pigs

Arterial waveform morphomics during hemorrhagic shock

Long-term mortality and quality of life after trauma: an ancillary study from the prospective multicenter trial FROG-ICU

Muscle fat content in the intact infraspinatus muscle correlates with age and BMI, but not critical shoulder angle

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie