Extraperitoneal pelvic packing as a way of surgical hemostasis in unstable pelvic injuries

Relevance. Mortality in pelvic injuries reaches 15 % and increases to 45–60 % in case of hemodynamic instability due to continuous massive bleeding. Intention. To determine the effectiveness of extraperitoneal pelvic packing (EPP) for surgical hemostasis in patients with unstable pelvic injuries and unstable hemodynamics. Methods. We analyzed treatment of 22 patients with unstable pelvic injuries and signs of hemodynamic instability in 2 firstlevel trauma clinics (St. Petersburg, 2013–2017). In all cases EPP was performed after mechanical stabilization of the pelvic ring to stop bleeding. Before and after EPP, the following hemostatis parameters were assessed: systolic blood pressure, volume of blood transfused, pH and base deficit, arterial blood lactate. Pelvic angiography was used to control and verify arterial bleeding sources. Results and Discussion. EPP made it possible to stop the ongoing pelvic bleeding in 14 (73.7 %) patients. EPP effectiveness was confirmed by statistically significant changes in mean systolic BP before and after packing, and a 3:1 ratio of the average volume of blood transfusion therapy. The total mortality rate was 14 (63.6 %) cases, 5 (22.7 %) patients died during the first day (mainly from irreversible blood loss), 9 patients (40.9 %) died within the first two weeks due to infectious complications. Our results are consistent with literature data. Conclusion. Extraperitoneal pelvic packing can be widely used in combination with mechanical stabilization of the damaged pelvic ring in patients with severe pelvic injuries. EPP does not exclude subsequent angiography and angioembolization.

disaster medicine, traumatology, polytrauma, unstable pelvic injuries, extraperitoneal pelvic packing, diagnostic pelvic angiography and selective embolization

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94.

95.