Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.

Hey, behind the Night listeners, it's your Miami Trauma team.

I'm Evo Rachega, I'm General Surgery resident, and I'm here with my other team members, Ori Nieman, our trauma fellow and Risha Ratana trauma attending for today's journal club episode will be focusing on blunt pelvic trauma.

Hemorrhage from blunt pelvic trauma is considered a non compressible torso hemorrhage, which presents a challenge to trauma surgeons.

It is often due to severe pelvic fractures and mortality in some series is still reported as high as 30%.

Somewhere between 80 to 90% of the time, this hemorrhage is due to bleeding from the sacral venous plexus.

Management of these injuries to prevent extinguination range from temporizing measures like pelvic binders to definitive surgery or embolization.

Today we'll discuss two studies that compare two common or possible hemorrhage control methods, pre-paratoneal pelvic packing and ribola.

Preparatoneal pelvic packing is a surgical procedure that involves packing the retro-paratoneal space to temporize major venous bleeding.

It was developed in Europe over 20 years ago and quickly moved to the US, and it's now used throughout the country and included in various pelvic hemorrhage management protocols.

The use of intra aortic occlusion methods for traumatic hemorrhage control was first reported in the mid-20th century, originating from the US Army experience during the Korean War.

While the first reports resulted in patient's death, future interest in such interventions continued, and more data was gathered.

Use of the intra aortic occlusion devices shifted to different civilian settings and technical advances with intra vascular therapeutics enabled safe reuse of the technique.

You might have heard quite a lot of the riboa by now, and you can certainly listen to the behind-the-knife big T-series episode two, which deep dives into riboa trauma usage in general.

To make a long story short, a unique population of patients who could benefit most from such use are patients with a blunt pelvic injury, where the deployment of the occlusion device below the renal arteries, that is, zone 3 of the orta, will be less of a concern for a visceral organischemia.

We'll start with the first study that we're going to discuss today. It was published in the Journal of the American College of Surgeons on January 2021.

It is titled Resuscitative Endovascular Balloon Occlusion of the Orta, versus Pre-Pertunia Packing in Patients with pelvic fractures by Samar Asmar and D and colleagues from the University of Arizona.

This is a retrospective study based on the 2017 Tiquet Database. The aim was to compare outcomes of riboa and or Pre-Pertunia Packing as temporizing measures in isolated, blunt, pelvic fracture patients.

The authors hypothesized that riboa is associated with worsened outcomes. That might have been, due to the fact that the members in this group were amongst the authors of a gem article, only two years prior where the authors found higher rates of complications among the reward book.

So for our study, inclusion criteria were patients 18-year-old and over with blunt pelvic fractures, with a systolic blood pressure equal to or below 100 millimeters of mercury, which they defined as a hemodynamically unstable.

Those patients were divided into three groups, either Pre-Pertunia Packing, Pre-Pertunia Packing with riboa and riboa only.

All of these patients had an additional intervention, which was a laparotomy, a trans arterial embolization or both, which patients were excluded from the study.

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