Inflate and pack! Pelvic packing combined with REBOA deployment prevents hemorrhage related deaths in unstable pelvic fractures.

Autor: Werner NL; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America. Electronic address: nicole.werner@cuanschutz.edu., Moore EE; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Hoehn M; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Lawless R; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Coleman JR; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Freedberg M; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Heelan AA; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Platnick KB; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Cohen MJ; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Coleman JJ; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Campion EM; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Fox CJ; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Mauffrey C; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Cralley A; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Pieracci FM; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America., Burlew CC; Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 United States of America.
Jazyk: angličtina
Zdroj: Injury [Injury] 2022 Oct; Vol. 53 (10), pp. 3365-3370. Date of Electronic Publication: 2022 Jul 16.
DOI: 10.1016/j.injury.2022.07.025
Abstrakt: Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is advocated for hemorrhage control in pelvic fracture patients in shock. We evaluated REBOA in patients undergoing preperitoneal pelvic packing (PPP) for pelvic fracture-related hemorrhage.
Methods: Retrospective, single-institution study of unstable pelvic fractures (hemodynamic instability despite 2 units of red blood cells (RBCs) and fracture identified on x-ray). Management included the placement of a Zone III REBOA in the emergency department (ED) for systolic blood pressure <80 mmHg. All PPP patients were included and analyzed for injury characteristics, transfusion requirements, outcomes and complications. Additionally, patients who received REBOA (REBOA+) were compared to those that did not (REBOA-).
Results: During the study period (January 2015 - January 2019), 652 pelvic fracture patients were admitted; 78 consecutive patients underwent PPP. Median RBCs at PPP completion compared to 24 h post-packing were 11 versus 3 units (p<0.05). Median time to operation was 45 min. After PPP, 7 (9%) patients underwent angioembolization. Mortality was 14%. No mortalities were due to ongoing pelvic fracture hemorrhage or physiologic exhaustion; all were a withdrawal of life sustaining support, most commonly due to neurologic insults (TBI/fat emboli = 6, stroke/spinal cord injury = 3). REBOA+ patients (n = 31) had a significantly higher injury severity score (45 vs 38, p<0.01) and higher heart rate (130 vs 118 beats per minute, p = 0.04) than REBOA-. The systolic blood pressure, base deficit, and number of RBCs transfused in the ED, and time spent in the ED were similar between groups. REBOA+ had a higher median transfusion of RBCs at PPP completion (11 units vs 5 units, p<0.01) but similar RBC transfusion in the 24 h after PPP (2 vs 1 units, p = 0.27). Mortality, pelvic infection, and ICU length of stay was not different between these cohorts.
Conclusion: PPP with REBOA was utilized in more severely injured patients with greater physiologic derangements. Although REBOA patients required greater transfusion requirements, there were no deaths due to acute pelvic hemorrhage. This suggests the combination of REBOA with PPP provides life-saving hemorrhage control in otherwise devastating injuries.
Competing Interests: Declaration of Competing Interest The authors have no COI/external funding aside from: Dr. Moore: Research support: Haemonetics, Instrumentation Laboratory, Stago, and Prytime; Co-founder: ThromboTherapeutics. Dr. Fox: Clinical Advisory Board, Prytime Medical Inc.
(Copyright © 2022. Published by Elsevier Ltd.)
Databáze: MEDLINE