Title : The immediate impact of pelvic arterial embolization on trauma patient with unstable pelvic fractures: A systemic review and meta-analysis
Abstract:
Transcatheter arterial embolization (TAE) has been reported to control hemorrhage and lower the mortality rate among patients with unstable pelvic fractures. However, there are limited literature examining the efficacy of TAE stopping hemorrhage in unstable pelvic fractures; the rate of transfusion pre–versus post–angioembolization; and the mortality among patients with unstable fractures who underwent embolization. The purpose of the study is to examine the effects of angioembolization on patients presenting with unstable pelvic fractures. The systematic search included PubMed; MEDLINE; EMBASE; CINAHL; ClinicalTrials.gov; and bibliographic reference lists. The primary outcome was defined as mortality, change in systolic blood pressure [pre- versus post–TAE], and change and rate of packed red blood cells (pRBC) transfusion [pre- versus post–TAE]. Among 3782 publications, 33 examined the mortality rate among patients undergoing angioembolization, 12 examined the rate of change in transfusion after TAE, and 8 systolic blood pressure [pre- versus post- TAE]. The 33 studies included 3492 patients who underwent angiography and 2154 embolization secondary to uncontrolled hemorrhage. A higher ISS is positively correlated with and mortality in the embolized group. The time from the injury to angiography is positively correlated with mortality rate among patient who underwent embolization. In the 12 studies, 407 underwent angioembolization. Patients were transfused an average of 1.67 Units pRBC/h before TAE, whereas 0.25 U pRBC/h after embolization. Further, 8 studies, which included 231 patients, evaluated change in systolic blood pressure (SBP). The average SBP was 85.6 mmHg prior to TAE and 96.8 mmHg after TAE. Angioembolization is effective in controlling hemorrhage by improving the systolic blood pressure and reducing mortality and rate of transfusion in hemodynamically unstable patients with unstable pelvic fractures. However, severe bleeding persists post-TAE. Therefore, resuscitative efforts must continue after embolization. Efforts should be taken towards rapid TAE and protocol-driven early embolization.
