Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture
<i>Background and Objectives:</i> C-clamp application may reduce mortality in patients with unstable pelvic fractures and hemodynamic instability. Decreasing C-clamp use over the past decades may have resulted from concerns about its effectiveness and safety. The purpose of this study wa...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-09-01
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| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/58/9/1291 |
| Summary: | <i>Background and Objectives:</i> C-clamp application may reduce mortality in patients with unstable pelvic fractures and hemodynamic instability. Decreasing C-clamp use over the past decades may have resulted from concerns about its effectiveness and safety. The purpose of this study was to document effective hemodynamic stabilization after C-clamp application by means of vital parameters (primary outcome parameter), and the subsequent effect on metabolic indices and volume management (secondary outcome parameters). <i>Materials and Methods:</i> C-clamp application was performed between 2014 and 2021 for <i>n</i> = 13 patients (50 ± 18 years) with unstable pelvic fractures and hemodynamic instability. Vital parameters, metabolic indices, volume management, and the correlation of factors and potential changes were analyzed. <i>Results</i>: After C-clamp application, increases were measured in systolic blood pressure (+15 mmHg; <i>p</i> = 0.0284) and mean arterial pressure (+12 mmHg; <i>p</i> = 0.0157), and a reduction of volume requirements (<i>p</i> = 0.0266) and bolus vasoactive medication needs (<i>p</i> = 0.0081) were observed. The earlier C-clamp application was performed, the greater the effect (<i>p</i> < 0.05; r > 0.6). Heart rate, shock index, and end-tidal CO<sub>2</sub> were not significantly altered. The extent of base deficit, hemoglobin, and lactate did not correlate with changes in vital parameters. <i>Conclusions</i>: In the majority of hemodynamically unstable trauma patients not responding to initial fluid resuscitation and severe pelvic fracture, early C-clamp application had an additive effect on hemodynamic stabilization and reduction in volume substitution. Based on these findings, there is still a rationale for considering early C-clamp stabilization in this group of severely injured patients. |
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| ISSN: | 1010-660X 1648-9144 |