Division of Surgery, Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
Eur J Trauma Emerg Surg. 2022 Feb;48(1):329-334. doi: 10.1007/s00068-020-01510-1. Epub 2020 Oct 9.
Angioembolization (AE) has been questioned as first-line modality for hemorrhage control of pelvic fracture (PF)-associated bleeding due to its potential inconsistent timely availability. We aimed to describe the patterns of AE use with hemostatic resuscitation and hypothesized that time to AE improved during the study period.
A Level-1 trauma center's prospective PF database was analyzed. All consecutive PFs referred to angiography between 01/01/2009 and 12/31/2018 were included. All suspected pelvic hemorrhage was managed with AE; pelvic packing was not performed. Demographics, injury/shock severity, 24-h transfusion data, time to AE and mortality were recorded. Data are presented as median (IQR).
During the 10-year study period, 1270 PF patients were treated. Thirty-six (2.8%) [75% male, 49 (33;65) years, ISS 36 (24;43), base deficit 3.65 (5.9;0.6), transfusions 4(2;7)] had AE. The indication for AE was clinical suspicion (CS) of pelvic bleeding [CS 24(67%)] or arterial blush on CT [CT 12 (33%)]. Median time to AE was 141 min for CS, and 223 min for CT, with no change over the study period. Patients with CS had a higher ISS, worse base deficit, greater transfusion requirements and faster time to AE. Five patients (14%) died. There were no deaths attributed to exsanguination.
Time to AE did not improve. Patients referred from CT are physiologically different from CS and should be analyzed accordingly, with CS resulting in faster time to AE in sicker patients. Contemporary resuscitation challenges the need for hyperacute AE as no patients exsanguinated despite time to AE of more than 2 h.
由于血管栓塞术（AE）的及时性并不稳定，因此其作为骨盆骨折（PF）相关出血的控制的一线治疗方式受到质疑。我们旨在描述使用 AE 进行止血复苏的模式，并假设在研究期间 AE 的时间有所改善。
分析了一家 1 级创伤中心的前瞻性 PF 数据库。纳入 2009 年 1 月 1 日至 2018 年 12 月 31 日期间所有接受血管造影的连续 PF 患者。所有疑似骨盆出血均采用 AE 治疗；未进行骨盆填塞。记录患者的人口统计学、损伤/休克严重程度、24 小时输血数据、AE 时间和死亡率。数据以中位数（IQR）表示。
在 10 年的研究期间，共治疗了 1270 例 PF 患者。36 例（2.8%）[75%为男性，49（33；65）岁，ISS 36（24；43），碱缺失 3.65（5.9；0.6），输血量 4（2；7）]接受了 AE。AE 的指征为骨盆出血的临床怀疑（CS）[CS 24（67%）]或 CT 上的动脉充血[CT 12（33%）]。CS 患者的 AE 中位时间为 141 分钟，CT 患者的 AE 中位时间为 223 分钟，在研究期间没有变化。CS 患者的 ISS 更高，碱缺失更严重，输血量更大，AE 时间更快。5 例患者（14%）死亡。没有因出血导致的死亡。
AE 时间没有改善。从 CT 转来的患者在生理上与 CS 不同，应该进行相应的分析，CS 导致病情更严重的患者的 AE 时间更快。当代复苏技术对超急性 AE 的需求提出了挑战，尽管 AE 时间超过 2 小时，但没有患者因出血而死亡。
