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Hemorrhage Interventions for Severe Pelvic Fractures and Pelvic Trauma

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Each month, the Penn Physician Blog features a review of recent journal publications by clinical researchers in the Department of Traumatology, Surgical Critical Care and Emergency Surgery at the University of Pennsylvania.

Our featured article for May 2021 was coauthored by Jeremy W. Cannon, MD, Trauma Medical Director and Section Chief of Trauma, and Mark Seamon, MD, FACS, Director of Research, Division of Traumatology, Surgical Critical Care and Emergency Surgery.

Drs. Cannon and Seamon’s report is the largest retrospective assessment to date of trauma centers within the United States on the outcome and management of patients having zone 3 REBOA deployment for the management of severe pelvic fractures.

Drs Cannon and Seamon

Jeremy Cannon, MD, and Mark Seamon, MD, FACS

Comparing Common Hemorrhage Interventions for Severe Pelvic Fractures

Interventions used at trauma centers to maintain proximal aortic pressure and minimize blood loss in life-threatening pelvic or lower limb hemorrhage in pelvic fractures vary widely in the United States owing to a lack of consensus on best practices and resource capabilities.

Common interventions in the clinical setting for hemorrhage control include preperitoneal pelvic packing (PP), angioembolization (AE), and external fixation (EF) of the pelvis.

Zone 3 resuscitative endovascular balloon occlusion of the aorta (REBOA) is an established first-line hemostatic therapy for pelvic fracture management to arrest arterial bleeding until hemostasis can be achieved. However, uncertainty remains regarding appropriate next steps to achieve definitive hemostasis after REBOA deployment.

Zone 3 REBOA Use: Patterns and Outcomes

A multi-center retrospective was conducted to review practice patterns for the deployment of zone 3 REBOA in the setting of severe pelvic fractures.

The study, which aimed to describe clinical outcomes based on number and types of interventions (including PP, AE and EF) after deployment of zone 3 resuscitative endovascular balloon occlusion of the aorta (REBOA), was published in April 2021 in the Journal of Trauma and Acute Care Surgery.

Patterns and outcomes of zone 3 REBOA use in the management of severe pelvic fractures: Results from the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database.

This study confirms that mortality and morbidity from this injury pattern remains high, but that REBOA is being used successfully as both a standalone hemorrhage control technique and as an adjunct in conjunction with other hemostatic techniques. The benefit of increasing number of interventions must be weighed against additional harm.

The integration of REBOA in severe pelvic fracture management alongside the myriad of additional hemostatic interventions must be studied in a concerted fashion to fill the crucial need for an evidence base to standardize care.

New Research from Penn Trauma

See other recent publications from Penn researchers in the Department of Traumatology, Surgical Critical Care and Emergency Surgery at the Perelman School of Medicine:

About this Blog

The Penn Physician Blog is a resource for health care professionals featuring Penn Medicine physicians and their research, innovations, programs and events. 

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