Understanding the Challenges in Extra-Peritoneal Packing for Pelvic Hemorrhage Control and Stabilization: Review

Maged Naser, Mohamed M. Nasr, Lamia H. Shehata

Abstract


Pelvic injuries are a serious concern, often leading to high mortality rates, even with various bleeding control methods in place. This study looks into how Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can impact mortality rates and hemodynamic stability. Both EPP and REBOA have shown to be effective, improving stability and serving as logical first steps in a collaborative treatment approach. Particularly, Zone I REBOA could be beneficial for critically ill patients facing multiple torso hemorrhages. Damage control surgery (DCS) is a multi-step surgical strategy designed for the rapid management of life-threatening bleeding, followed by physiological stabilization and definitive repairs. Abdomino-pelvic packing (APP) inserting compressive materials into the abdomen and/or pelvis to control bleeding is a critical part of DCS. This review gathers existing research on DCS, focusing on APP, a technique initially developed for trauma and orthopedic surgery but applicable in gynecological and obstetric emergencies. We’ll cover its historical development, physiological basis, and a systematic protocol for DCS tailored to specific situations, including postpartum hemorrhage, placenta accreta spectrum, uterine rupture, hepatic rupture in HELLP syndrome, and various oncological and non-cancerous surgeries. Modern adjuncts like early tranexamic acid administration, topical hemostatic agents, and coordinated multidisciplinary efforts have shifted packing from a last resort to a vital part of staged hemorrhage control. In obstetrics and gynecology, APP achieves effective hemostasis in 75 to 90 % of cases, leading to lower mortality rates compared to trauma surgeries. In conclusion, APP should be included in standardized protocols for handling hemorrhages in obstetrics and gynecology. Effective training, simulations, and adherence to guidelines are crucial, particularly in resource-limited settings where advanced treatments may not be-available.

Keywords


Damage Control Surgery; Pelvic Packing; Obstetric Hemorrhage; Postpartum Hemorrhage; Placenta Accreta Spectrum; Gynecologic Surgery; Massive Hemorrhage; Tranexamic Acid; Hemostatic-Agents; Surgical-Emergencies.

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References


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DOI: http://dx.doi.org/10.52155/ijpsat.v54.1.7657

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