Clinical Review: Initial Management of Blunt Pelvic Trauma Patients with Haemodynamic Instability

Overview

Journal Crit Care

Specialty Critical Care

Date 2007 Feb 16

PMID 17300738

Citations 19

Authors

Thomas Geeraerts

Vibol Chhor

Gaelle Cheisson

Laurent Martin

Bertrand Bessoud

Augustin Ozanne

Jacques Duranteau

Affiliations

Soon will be listed here.

Abstract

Pelvic trauma can lead to severe, uncontrollable haemorrhage and death related to prolonged shock and multiple organ failure. Massive retroperitoneal haematoma should be assumed to be present in cases of post-traumatic haemodynamic instability associated with pelvic fracture in the absence of extrapelvic haemorrhagic lesions. This review describes the pathophysiology of retroperitoneal haematoma in trauma patient with blunt pelvic fracture, considering the roles of venous and arterial bleeding. Efficacy and safety of haemostatic procedures are also discussed, and particular attention is given to the efficacy of pelvic angiographic embolization and external pelvic fixation. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture that takes haemodynamic status and associated lesions into account.

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References

Sieber P . Bladder necrosis secondary to pelvic artery embolization: case report and literature review. J Urol. 1994; 151(2):422. DOI: 10.1016/s0022-5347(17)34969-8. View

Smith W, Moore E, Osborn P, Agudelo J, Morgan S, Parekh A . Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representative cases and a description of technique. J Trauma. 2006; 59(6):1510-4. DOI: 10.1097/01.ta.0000197330.81352.94. View

Cerva Jr D, Mirvis S, Shanmuganathan K, Kelly I, Pais S . Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT. AJR Am J Roentgenol. 1996; 166(1):131-5. DOI: 10.2214/ajr.166.1.8571861. View

Cothren C, Moore E, Smith W, Morgan S . Preperitoneal pelvic packing in the child with an unstable pelvis: a novel approach. J Pediatr Surg. 2006; 41(4):e17-9. DOI: 10.1016/j.jpedsurg.2006.01.014. View

Agolini S, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed 3rd J . Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma. 1997; 43(3):395-9. DOI: 10.1097/00005373-199709000-00001. View

Grimm M, Vrahas M, Thomas K . Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma. 1998; 44(3):454-9. DOI: 10.1097/00005373-199803000-00006. View

Bassam D, Cephas G, Ferguson K, Beard L, Young J . A protocol for the initial management of unstable pelvic fractures. Am Surg. 1998; 64(9):862-7. View

Bell R, Krantz B, Weigelt J . ATLS: a foundation for trauma training. Ann Emerg Med. 1999; 34(2):233-7. DOI: 10.1016/s0196-0644(99)70238-6. View

Stephen D, Kreder H, Day A, McKee M, Schemitsch E, ElMaraghy A . Early detection of arterial bleeding in acute pelvic trauma. J Trauma. 1999; 47(4):638-42. DOI: 10.1097/00005373-199910000-00006. View

10.

SEAVERS R, Lynch J, Ballard R, Jernigan S, Johnson J . HYPOGASTRIC ARTERY LIGATION FOR UNCONTROLLABLE HEMORRHAGE IN ACUTE PELVIC TRAUMA. Surgery. 1964; 55:516-9. View

11.

Velmahos G, Chahwan S, Falabella A, Hanks S, Demetriades D . Angiographic embolization for intraperitoneal and retroperitoneal injuries. World J Surg. 2000; 24(5):539-45. DOI: 10.1007/s002689910087. View

12.

Dickinson K, Roberts I . Medical anti-shock trousers (pneumatic anti-shock garments) for circulatory support in patients with trauma. Cochrane Database Syst Rev. 2000; (2):CD001856. PMC: 8408677. DOI: 10.1002/14651858.CD001856. View

13.

Hamill J, Holden A, Paice R, Civil I . Pelvic fracture pattern predicts pelvic arterial haemorrhage. Aust N Z J Surg. 2000; 70(5):338-43. DOI: 10.1046/j.1440-1622.2000.01822.x. View

14.

Wong Y, Wang L, Ng C, Tseng I, See L . Mortality after successful transcatheter arterial embolization in patients with unstable pelvic fractures: rate of blood transfusion as a predictive factor. J Trauma. 2000; 49(1):71-5. DOI: 10.1097/00005373-200007000-00010. View

15.

Velmahos G, Chahwan S, Hanks S, Murray J, Berne T, Asensio J . Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis. Am Surg. 2000; 66(9):858-62. View

16.

Pereira S, OBrien D, Luchette F, Choe K, Lim E, Davis Jr K . Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture. Surgery. 2000; 128(4):678-85. DOI: 10.1067/msy.2000.108219. View

17.

Takahira N, Shindo M, Tanaka K, Nishimaki H, Ohwada T, Itoman M . Gluteal muscle necrosis following transcatheter angiographic embolisation for retroperitoneal haemorrhage associated with pelvic fracture. Injury. 2001; 32(1):27-32. DOI: 10.1016/s0020-1383(00)00098-x. View

18.

Biffl W, Smith W, Moore E, Gonzalez R, Morgan S, Hennessey T . Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg. 2001; 233(6):843-50. PMC: 1421328. DOI: 10.1097/00000658-200106000-00015. View

19.

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(7):468-74. DOI: 10.1097/00005131-200109000-00002. View

20.

Routt Jr M, Falicov A, Woodhouse E, Schildhauer T . Circumferential pelvic antishock sheeting: a temporary resuscitation aid. J Orthop Trauma. 2002; 16(1):45-8. DOI: 10.1097/00005131-200201000-00010. View