Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis

Abstract

This SRMA compares the use of angioembolization versus pre-peritoneal packing for the management of bleeding pelvic ring injuries.

Extraperitoneal pelvic packing versus angiographic embolization for hemodynamically unstable pelvic fractures: a retrospective single-center analysis

“…This can be attributed to the proficient surgical skills and extensive clinical experience of the surgical team coupled with the significant advancements in interventional techniques and the enhancement of embolization materials in recent years. Consistent with this, a review by McDonogh et al 8 of literature published from 2000 to 2020 indicated a gradual, albeit subtle, decline in the overall mortality rate among patients who underwent AE, a trend not observed in the EPP group.…”

“…21 With the ongoing advancements in medical instruments, materials, and AE techniques, increasing numbers of trauma centers are adopting AE as the preferred treatment method. 8 Conversely, EPP is a more invasive procedure that requires a follow-up surgery to remove the pelvic packing, thereby significantly elevating the risk of infection. 13,14 Consequently, our center predominantly performs AE, which explains the disparity in the sample sizes between the two groups in this study.…”

“…A retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program database from 2016 to 2018 showed no significant difference in in-hospital survival between the AE and preperitoneal packing groups, although preperitoneal packing was more frequently chosen for severe pelvic fractures necessitating laparotomy. 8 Moreover, a systematic review and meta-analysis underscored the difficulty in comparing these two modalities because of biases, heterogeneity, and inadequate reporting of physiological data, emphasizing the need for standardized reporting in this high-risk group of trauma patients. 9 Since the first report of AE by Margolies et al 10 in 1972, this technique has undergone several decades of development and improvement and is now widely applied in the treatment of traumatic pelvic fractures.…”

Preperitoneal Packing for Pelvic Fracture Bleeding Control: A Human Cadaver Study

“…Attempting to directly compare outcomes of the various therapeutic interventions for bleeding control from pelvic fractures, is very difficult and may lead to the wrong conclusions, because of the bias and major heterogeneity of the reported study populations. In addition, the major changes in the resuscitation and blood transfusion protocols in the last few years make any outcome comparisons between older and more recent studies unreliable [12].…”

“…In addition, the authors expressed concern that PPP may potentially delay the definitive treatment of angiographic intervention, which was highly effective in this series. McDonogh et al, in a systematic review and meta-analysis of 18 studies with a total of 579 patients, of which 402 were treated with PPP and 177 with angioembolization, reported that 27% of patients treated with PPP did not achieve bleeding control and required subsequent angioembolization [12].…”