Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment
Purpose: Traditional maneuvers aim to decrease retroperitoneal bleeding in hemodynamically unstable multi-trauma patients with unstable pelvic fractures, are reportedly successful in approximately only 50%. The life-saving effect of extra-peritoneal pressure packing (EPPP) is based on direct compres...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2015-01-01
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| Series: | Journal of Emergencies, Trauma and Shock |
| Subjects: | |
| Online Access: | http://www.onlinejets.org/article.asp?issn=0974-2700;year=2015;volume=8;issue=4;spage=181;epage=187;aulast=Ron |
| _version_ | 1811298929915985920 |
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| author | Guy Ron Dan Epstein Peleg Ben-Galim Yoram Klein Alexander Kaban Shaul Sagiv |
| author_facet | Guy Ron Dan Epstein Peleg Ben-Galim Yoram Klein Alexander Kaban Shaul Sagiv |
| author_sort | Guy Ron |
| collection | DOAJ |
| description | Purpose: Traditional maneuvers aim to decrease retroperitoneal bleeding in hemodynamically unstable multi-trauma patients with unstable pelvic fractures, are reportedly successful in approximately only 50%. The life-saving effect of extra-peritoneal pressure packing (EPPP) is based on direct compression and control of both venous and arterial retroperitoneal bleeders. This study describes the safety and efficacy of emergent EPPP employment, as a stand-alone surgical treatment, that is, carried out without external pelvic fixation or emergent angiography. Materials and Methods: A retrospective chart review of all hemodynamic unstable, multi-trauma patients with mechanically unstable pelvic fractures treated by the EPPP technique at our medical center between the years 2005 and 2011. Survival rates, clinical, and physiological outcomes were followed prospectively. Results: Twenty-five of the 181 pelvic fracture patients had biomechanically unstable fractures that required surgical fixation. Fourteen of those 25 patients had deteriorating hemodynamic instability from massive pelvic bleeding which was resistant to resuscitation, and they underwent EPPP, as a stand-alone treatment. The procedure successfully achieved hemodynamic stability in all 14 patients and obviated the early mortality associated with massive pelvic bleeding. Three of these patients eventually succumbed to their multiple injuries. Conclusion: Implementation of EPPP improved all measured physiological outcome parameters and survival rates of hemodynamically unstable multi-trauma patients with unstable pelvic fractures in our trauma center. It provided the unique advantage of directly compressing the life-threatening retroperitoneal bleeders by applying direct pressure and causing a tamponade effect to stanch venous and arterial pelvic blood flow and obviate the early mortality associated with massive pelvic bleeding. |
| first_indexed | 2024-04-13T06:27:38Z |
| format | Article |
| id | doaj.art-8491383bb7864cc3bc5b5110cef9ead8 |
| institution | Directory Open Access Journal |
| issn | 0974-2700 |
| language | English |
| last_indexed | 2024-04-13T06:27:38Z |
| publishDate | 2015-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Emergencies, Trauma and Shock |
| spelling | doaj.art-8491383bb7864cc3bc5b5110cef9ead82022-12-22T02:58:22ZengWolters Kluwer Medknow PublicationsJournal of Emergencies, Trauma and Shock0974-27002015-01-018418118710.4103/0974-2700.166586Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatmentGuy RonDan EpsteinPeleg Ben-GalimYoram KleinAlexander KabanShaul SagivPurpose: Traditional maneuvers aim to decrease retroperitoneal bleeding in hemodynamically unstable multi-trauma patients with unstable pelvic fractures, are reportedly successful in approximately only 50%. The life-saving effect of extra-peritoneal pressure packing (EPPP) is based on direct compression and control of both venous and arterial retroperitoneal bleeders. This study describes the safety and efficacy of emergent EPPP employment, as a stand-alone surgical treatment, that is, carried out without external pelvic fixation or emergent angiography. Materials and Methods: A retrospective chart review of all hemodynamic unstable, multi-trauma patients with mechanically unstable pelvic fractures treated by the EPPP technique at our medical center between the years 2005 and 2011. Survival rates, clinical, and physiological outcomes were followed prospectively. Results: Twenty-five of the 181 pelvic fracture patients had biomechanically unstable fractures that required surgical fixation. Fourteen of those 25 patients had deteriorating hemodynamic instability from massive pelvic bleeding which was resistant to resuscitation, and they underwent EPPP, as a stand-alone treatment. The procedure successfully achieved hemodynamic stability in all 14 patients and obviated the early mortality associated with massive pelvic bleeding. Three of these patients eventually succumbed to their multiple injuries. Conclusion: Implementation of EPPP improved all measured physiological outcome parameters and survival rates of hemodynamically unstable multi-trauma patients with unstable pelvic fractures in our trauma center. It provided the unique advantage of directly compressing the life-threatening retroperitoneal bleeders by applying direct pressure and causing a tamponade effect to stanch venous and arterial pelvic blood flow and obviate the early mortality associated with massive pelvic bleeding.http://www.onlinejets.org/article.asp?issn=0974-2700;year=2015;volume=8;issue=4;spage=181;epage=187;aulast=RonExtra-peritoneal packinghemodynamic instabilitymulti-traumapelvic fracturessalvage procedure |
| spellingShingle | Guy Ron Dan Epstein Peleg Ben-Galim Yoram Klein Alexander Kaban Shaul Sagiv Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment Journal of Emergencies, Trauma and Shock Extra-peritoneal packing hemodynamic instability multi-trauma pelvic fractures salvage procedure |
| title | Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment |
| title_full | Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment |
| title_fullStr | Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment |
| title_full_unstemmed | Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment |
| title_short | Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment |
| title_sort | extra peritoneal pressure packing without external pelvic fixation a life saving stand alone surgical treatment |
| topic | Extra-peritoneal packing hemodynamic instability multi-trauma pelvic fractures salvage procedure |
| url | http://www.onlinejets.org/article.asp?issn=0974-2700;year=2015;volume=8;issue=4;spage=181;epage=187;aulast=Ron |
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