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Intra-Aortic Balloon Occlusion to Salvage Patients With Life-Threatening Hemorrhagic Shocks From Pelvic Fractures

Martinelli, Thomas MD; Thony, Frédéric MD; Decléty, Philippe MD; Sengel, Christian MD; Broux, Christophe MD; Tonetti, Jérôme MD, PhD; Payen, Jean-François MD, PhD; Ferretti, Gilbert MD, PhD

Journal of Trauma-Injury Infection & Critical Care: April 2010 - Volume 68 - Issue 4 - pp 942-948
doi: 10.1097/TA.0b013e3181c40579
Original Article

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.

From the Department of Radiology and Medical Imaging (T.M., F.T., G.F.), Department of Anesthesiology and Critical Care (P.D., C.B., J.-F.P.), Department of Orthopedic Surgery (J.T.), Grenoble University Hospital, Grenoble, France.

Submitted for publication December 15, 2008.

Accepted for publication September 30, 2009.

The IABO method described in the study should be reserved to patients in critically uncontrollable hemorrhagic shock (CUHS) and is not a first-line treatment of pelvic fractures in hemorrhagic shock.

Address for reprints: Thomas Martinelli, MD, CHRU Lille, Service de Radiologie, Hôpital Cardiologique, Bd du Pr Jules Leclercq, 59037 Lille Cedex, France; email: thomas.martinelli@chru-lille.fr.

© 2010 Lippincott Williams & Wilkins, Inc.