Document Detail


Intra-aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures.
MedLine Citation:
PMID:  20173661     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to describe a blinded intra-aortic balloon occlusion (IABO) procedure in pelvic fractures (PF) for patients with critically uncontrollable hemorrhagic shock (CUHS). METHODS: Of 2,064 patients treated for PF, 13 underwent IABO during initial resuscitation to control massive pelvic bleeding leading to CUHS. Our IABO procedure consists of internal aortic occlusion without fluoroscopy, using a latex balloon inflated in the infrarenal aorta. Retrospectively collected data included demographics, fracture classification, additional injuries, blood transfusions, surgical interventions, angiographic procedure, physiologic parameters, and survival. RESULTS: All balloons were successfully placed, and a significant increase in systolic blood pressure (70 mm Hg, p = 0.001) was observed immediately after IABO. Twelve of 13 patients became transferrable. Angiography performed after IABO was positive for arterial injury in 92% of patients, and 9 patients benefitted from arterial embolization. Survival rate was 46% (6 of 13) and was inversely related to the length of inflation (p = 0.026) and the mean Injury Severity Score (p = 0.011). CONCLUSION: This IABO procedure can be life saving in the management of patients with CUHS from PF, permitting transport to angiography. However, the decision for such treatment must be as quickly as possible after trauma to reduce the time of occlusion.
Authors:
Thomas Martinelli; Frédéric Thony; Philippe Decléty; Christian Sengel; Christophe Broux; Jérôme Tonetti; Jean-François Payen; Gilbert Ferretti
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  68     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-13     Completed Date:  2010-05-06     Revised Date:  2010-10-18    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  942-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Radiology and Medical Imaging, Grenoble University Hospital, Grenoble, France. thomas.martinelli@chru-lille.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Angiography
Aorta, Abdominal*
Balloon Occlusion / methods*
Blood Transfusion / statistics & numerical data
Female
Fractures, Bone / complications*
Humans
Injury Severity Score
Male
Pelvic Bones / injuries*,  surgery*
Retrospective Studies
Salvage Therapy*
Shock, Hemorrhagic / etiology,  therapy*
Survival Rate
Treatment Outcome
Comments/Corrections
Comment In:
J Trauma. 2010 Oct;69(4):1005-6; author reply 1006-7   [PMID:  20938300 ]

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