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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-09-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/9/1291 |
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| author | Jan Gewiess Markus Martin Luedi Beat Schnüriger Theodoros Hercules Tosounidis Marius Johann Baptist Keel Johannes Dominik Bastian |
| author_facet | Jan Gewiess Markus Martin Luedi Beat Schnüriger Theodoros Hercules Tosounidis Marius Johann Baptist Keel Johannes Dominik Bastian |
| author_sort | Jan Gewiess |
| collection | DOAJ |
| description | <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 |
| language | English |
| last_indexed | 2024-03-09T23:12:49Z |
| publishDate | 2022-09-01 |
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| series | Medicina |
| spelling | doaj.art-8d65be7db01c4e128415f46b797fb9bc2023-11-23T17:41:13ZengMDPI AGMedicina1010-660X1648-91442022-09-01589129110.3390/medicina58091291Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic FractureJan Gewiess0Markus Martin Luedi1Beat Schnüriger2Theodoros Hercules Tosounidis3Marius Johann Baptist Keel4Johannes Dominik Bastian5Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Visceral Surgery and Medicine, Acute Care Surgery Team, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Orthopaedic Surgery, University Hospital Heraklion Crete, 71500 Heraklion, Crete, GreeceDepartment of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland<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.https://www.mdpi.com/1648-9144/58/9/1291pelvic C-clamphemodynamic instabilitypelvic ring fractureemergency management |
| spellingShingle | Jan Gewiess Markus Martin Luedi Beat Schnüriger Theodoros Hercules Tosounidis Marius Johann Baptist Keel Johannes Dominik Bastian Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture Medicina pelvic C-clamp hemodynamic instability pelvic ring fracture emergency management |
| title | Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture |
| title_full | Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture |
| title_fullStr | Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture |
| title_full_unstemmed | Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture |
| title_short | Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture |
| title_sort | effect of c clamp application on hemodynamic instability in polytrauma victims with pelvic fracture |
| topic | pelvic C-clamp hemodynamic instability pelvic ring fracture emergency management |
| url | https://www.mdpi.com/1648-9144/58/9/1291 |
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