Preperitoneal balloon tamponade for lethal closed retroperitoneal pelvic hemorrhage in a swine model
| Autor: | Matthew J. Eckert, Kenji Inaba, Michelle Y. Song, Sandra B. Willey, Matthew J. Martin, Shannon T. Marko, Kyle K. Sokol, George E. Black |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Mean arterial pressure Swine Balloon tamponade medicine.medical_treatment Cardiac index Hemodynamics Shock Hemorrhagic Critical Care and Intensive Care Medicine Balloon Pelvis 03 medical and health sciences 0302 clinical medicine medicine Animals Retroperitoneal space Retroperitoneal Space 030212 general & internal medicine medicine.diagnostic_test Hemostatic Techniques business.industry 030208 emergency & critical care medicine Balloon Occlusion Surgery Disease Models Animal medicine.anatomical_structure Angiography Tamponade business |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 81:1046-1055 |
| ISSN: | 2163-0755 |
| DOI: | 10.1097/ta.0000000000001262 |
| Popis: | BACKGROUND The management of massive pelvic fracture-associated hemorrhage is extremely challenging, particularly in the unstable patient. We sought to characterize and compare the efficacy of a minimally invasive preperitoneal balloon technique (MIB) to standard open packing. METHODS Twenty-six swine were randomized to control (C), open preperitoneal packing technique (OP), and MIB groups. A closed extraperitoneal iliac vascular injury followed by intervention + resuscitation over a 120-minute OP and MIB efficacy was assessed by procedure time, hemodynamics, extraperitoneal tamponade pressures (ETPs), blood loss, and survival. Angiography was performed in select animals, and ETPs were also measured in humans undergoing MIB placement for an elective procedure. RESULTS Baseline parameters (mean arterial pressure [MAP] 29, 38, and 38 mm Hg; cardiac index [CI] 3.5, 3.8, and 4.2; and EPTs 5, 4, and 5 mm Hg) were similar among C, OP, and MIB groups, respectively (all p's > 0.05). The OP and MIB groups had markedly improved MAP and CI versus C. MIB generated significantly higher ETP (28 vs 17 mm Hg), was faster to deploy (164 vs 497 seconds), and had lower total blood loss versus OP (0.7 vs 1.2 L, all p's < 0.05). OP and MIB had equivalent survival times that were significantly improved versus C (91 and 116 vs 43 minutes, p < 0.05). Survival to 2 hours was 80% with OP versus 100% in the MIB group. Angiography showed no active extravasation in both study groups, but controlled partial deflation of the MIB allowed easy visualization of extravasation. Minimally invasive preperitoneal balloon inflation in five human subjects demonstrated a significant increase in mean ETP from 2.4 to 31 mm Hg (p < 0.01). CONCLUSION Minimally invasive preperitoneal balloon tamponade was as effective as OP in improving hemodynamics and prolonging survival times, and performed superiorly to OP in time to placement, blood loss, and generation of tamponade pressures. The MIB allows for controlled deflation and reinflation to facilitate angiographic interventions, and may represent a promising new bedside intervention in this patient population. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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