Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review.

OBJECTIVE To assess the role of pelvic packing as an emergency therapeutic intervention in pelvic fractures with concomitant haemodynamic instability. METHODS A systematic review of the literature in English from the past two decades yielded only three eligible studies. Clinical and methodological heterogeneity across the component studies was assessed by careful recording of certain descriptive characteristics. Statistical heterogeneity was detected using Cochran chi-square and I2 tests. The principal outcomes of interest were early mortality (within 24 hours of injury), late mortality (within the first month) and certain complications (infection and multiple organ failure (MOF)). RESULTS Methodological and clinical heterogeneity was evident across component studies, although it was not strongly associated with the observed results. All component studies were assigned a low to moderate quality score. The pooled estimates of effect size for mortality were as follows: early mortality rate 10% (95% confidence intervals [95 CI]: 3-18%), late mortality rate 13% (95 CI: 5-22%), overall mortality 28% (95 CI: 16.8-39.4%). As for the recorded complications, a pooled estimate of 35%, (95 CI: 21-48%) was calculated for infection rate and 9%, (95 CI: 2-16%) for MOF rate. Apart from one study, in which pelvic packing was used exclusively as an emergency resuscitative procedure, pelvic angiography played a significant complementary role to pelvic packing for final haemorrhage control in the other two studies. CONCLUSION Haemodynamically unstable pelvic ring injuries are characterised by significant mortality and complications. Pelvic packing, as a part of a damage control protocol, could potentially aid in early intrapelvic bleeding control and provide crucial time for a more selective management of haemorrhage.