EXTRAPERITONEAL PELVIC PACKING–A SALVAGE PROCEDURE TO CONTROL MASSIVE PELVIC HAEMORRHAGE

Abstract

Objective: To assess the impact of EPP on physiological parameters in hemodynamically unstable patients with blunt pelvic trauma.

Methods: Of 661 patients treated for pelvic trauma, 18 consecutive patients in shock underwent EPP with the intent to control massive pelvic bleeding. These patients constituted the study population. Data collected from the medical records and the Ullev̊l Trauma Registry included: demographics, fracture classification, additional injuries, blood transfusions, surgical interventions, angiographic procedure, physiological parameters and outcome. An association between continuous variables was calculated using the Spearman correlation coefficient. A comparison between means was calculated using the t-test.

Results: Mean patient age was 44 years (range 16–80). ISS 47 (9–66). 39 % had non-measurable blood pressure at admission. Survival rate within 30 days was 72% (13/18) and correlated inversely to the age of the patient (p=0.038). Only one non-survivor died of exsanguination from multiple bleeding foci. A significant increase in systolic blood pressure (p=0.002) and hemoglobin count (p=0.012) was observed immediately after EPP. Arterial injury was observed in 80% of patients who underwent angiography after EPP.

Conclusions: 30-day survival rate after EPP was 72 %. A significant increase in systolic blood pressure and hemoglobin count was observed immediately after EPP, indicating that EPP as part of a multi-interventional resuscitation protocol may be life-saving in patients with exsanguinating pelvic injury. However, the high rate of arterial injuries seen after EPP indicates that the procedure should be supplemented with angiography once the patient is stabilized for transfer to the angiography suite.