Early embolization and vasopressor administration for management of life-threatening hemorrhage from pelvic fracture.
BACKGROUND
In this retrospective study, we reviewed our protocol for management of hemodynamically unstable patients with pelvic injury.


METHODS
We managed the patients with the same predetermined plan including controlled hemodynamic resuscitation with early use of vasopressors and pelvic angiography as a first-line treatment.


RESULTS
Of 311 patients with pelvic fracture, 32 hemodynamically unstable patients (10.3%) underwent pelvic angiography, which was followed by embolization in 25 cases. Angiography was successful for 24 patients (96%) and extrapelvic bleeding was diagnosed in 5 patients (15%). Three of six laparotomies performed before angiography were nontherapeutic. One of seven laparotomies performed after angiography was negative.


CONCLUSIONS
A protocol for management of patients with pelvic injury and hemodynamic instability that is associated with controlled resuscitation including vasopressor and early pelvic angioembolization is effective for treating pelvic hemorrhage and diagnosing extrapelvic hemorrhage. Further studies are needed to confirm the respective place of angiographic and surgical control of bleeding.
Fangio
Pascal
P
Service d'Anesthésie-Réanimation et Unité Propre de Recherche de l'Enseignement Supérieur-Equipe d'Accueil, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
Asehnoune
Karim
K
Edouard
Alain
A
Smail
Nadia
N
Benhamou
Dan
D
D000328:Adult; D000792:Angiography / Q000706:statistics & numerical data; D001158:Arteries / Q000293:injuries; D015897:Comorbidity; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000453:epidemiology* / Q000628:therapy; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents