Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture: Early experience in a Korean trauma center

Ji Young Jang, Hongjin Shim, Pil Young Jung, Seongyup Kim, Keumseok Bae

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: The mortality rate of patients with hemodynamic instability due to severe pelvic fracture is reported to be 40-60 % despite a multidisciplinary treatment approach. Angioembolization and external fixation of the pelvis are the main procedures used to control bleeding in these patients. Several studies have shown that preperitoneal pelvic packing (PPP) is effective for hemorrhage control, despite being small and observational in nature. The purpose of this study was to describe a Korean trauma center's early experience with PPP in unstable patients with pelvic fractures and to evaluate its effectiveness. Methods: Between January 2012 and May 2015, 30 patients with hemodynamic instability caused by pelvic fracture were enrolled in this study. PPP has been performed in 14 patients since May 2014. Data of pelvic fracture patients with hemodynamic instability were selected from Wonju Severance Christian Hospital Pelvic Trauma Database and were analyzed retrospectively. Results: Mean age and mean ISS were 60.4 ± 18.8 years and 39.2 ± 8.1 in 30 unstable patients with pelvic fracture. Mean SBP was 89.1 ± 24.7 mmHg, and mean hemoglobin was 10.6 ± 2.3 g/dL. When the non-PPP group (16 patients) and the PPP group (14 patients) were compared, there was no significant difference in the age, gender, ISS, and occurrence of associated injury (p = 0.82, p = 0.23, p = 0.92, and p = 0.60, respectively). Mortality rate due to acute hemorrhage were 37.5 % in the non-PPP group and 14.3 % in the PPP group. In the PPP group, three patients underwent PPP in the hybrid operating room, and a laparotomy was performed in three patients. Mean systolic blood pressure increased significantly after PPP (71.6 ± 9.8 vs. 132.2 ± 36.4 mmHg, p = 0.002). Conclusions: In unstable patients with pelvic fractures, PPP can be used as an effective treatment, complementary to AE, to control pelvic bleeding.

Original languageEnglish
Article number3
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume24
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1

Fingerprint

Trauma Centers
Hemodynamics
Hemorrhage
Blood Pressure
Mortality
Wounds and Injuries
Operating Rooms
Pelvis
Laparotomy
Hemoglobins
Databases

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

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title = "Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture: Early experience in a Korean trauma center",
abstract = "Background: The mortality rate of patients with hemodynamic instability due to severe pelvic fracture is reported to be 40-60 {\%} despite a multidisciplinary treatment approach. Angioembolization and external fixation of the pelvis are the main procedures used to control bleeding in these patients. Several studies have shown that preperitoneal pelvic packing (PPP) is effective for hemorrhage control, despite being small and observational in nature. The purpose of this study was to describe a Korean trauma center's early experience with PPP in unstable patients with pelvic fractures and to evaluate its effectiveness. Methods: Between January 2012 and May 2015, 30 patients with hemodynamic instability caused by pelvic fracture were enrolled in this study. PPP has been performed in 14 patients since May 2014. Data of pelvic fracture patients with hemodynamic instability were selected from Wonju Severance Christian Hospital Pelvic Trauma Database and were analyzed retrospectively. Results: Mean age and mean ISS were 60.4 ± 18.8 years and 39.2 ± 8.1 in 30 unstable patients with pelvic fracture. Mean SBP was 89.1 ± 24.7 mmHg, and mean hemoglobin was 10.6 ± 2.3 g/dL. When the non-PPP group (16 patients) and the PPP group (14 patients) were compared, there was no significant difference in the age, gender, ISS, and occurrence of associated injury (p = 0.82, p = 0.23, p = 0.92, and p = 0.60, respectively). Mortality rate due to acute hemorrhage were 37.5 {\%} in the non-PPP group and 14.3 {\%} in the PPP group. In the PPP group, three patients underwent PPP in the hybrid operating room, and a laparotomy was performed in three patients. Mean systolic blood pressure increased significantly after PPP (71.6 ± 9.8 vs. 132.2 ± 36.4 mmHg, p = 0.002). Conclusions: In unstable patients with pelvic fractures, PPP can be used as an effective treatment, complementary to AE, to control pelvic bleeding.",
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Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture : Early experience in a Korean trauma center. / Jang, Ji Young; Shim, Hongjin; Jung, Pil Young; Kim, Seongyup; Bae, Keumseok.

In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol. 24, No. 1, 3, 01.01.2016.

Research output: Contribution to journalArticle

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T1 - Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture

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AB - Background: The mortality rate of patients with hemodynamic instability due to severe pelvic fracture is reported to be 40-60 % despite a multidisciplinary treatment approach. Angioembolization and external fixation of the pelvis are the main procedures used to control bleeding in these patients. Several studies have shown that preperitoneal pelvic packing (PPP) is effective for hemorrhage control, despite being small and observational in nature. The purpose of this study was to describe a Korean trauma center's early experience with PPP in unstable patients with pelvic fractures and to evaluate its effectiveness. Methods: Between January 2012 and May 2015, 30 patients with hemodynamic instability caused by pelvic fracture were enrolled in this study. PPP has been performed in 14 patients since May 2014. Data of pelvic fracture patients with hemodynamic instability were selected from Wonju Severance Christian Hospital Pelvic Trauma Database and were analyzed retrospectively. Results: Mean age and mean ISS were 60.4 ± 18.8 years and 39.2 ± 8.1 in 30 unstable patients with pelvic fracture. Mean SBP was 89.1 ± 24.7 mmHg, and mean hemoglobin was 10.6 ± 2.3 g/dL. When the non-PPP group (16 patients) and the PPP group (14 patients) were compared, there was no significant difference in the age, gender, ISS, and occurrence of associated injury (p = 0.82, p = 0.23, p = 0.92, and p = 0.60, respectively). Mortality rate due to acute hemorrhage were 37.5 % in the non-PPP group and 14.3 % in the PPP group. In the PPP group, three patients underwent PPP in the hybrid operating room, and a laparotomy was performed in three patients. Mean systolic blood pressure increased significantly after PPP (71.6 ± 9.8 vs. 132.2 ± 36.4 mmHg, p = 0.002). Conclusions: In unstable patients with pelvic fractures, PPP can be used as an effective treatment, complementary to AE, to control pelvic bleeding.

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