Clinical study
Embolization for Multicompartmental Bleeding in Patients in Hemodynamically Unstable Condition: Prognostic Factors and Outcome

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Abstract

Purpose

To determine prognostic factors and evaluate outcomes of transcatheter arterial embolization in severely injured patients in hemodynamically unstable condition with multicompartmental bleeding.

Materials and Methods

Between June 2000 and May 2008, 36 consecutive patients treated with transcatheter arterial embolization for major retroperitoneal bleeding associated with at least one additional source of bleeding were retrospectively reviewed. Mean Injury Severity Score (ISS) was 49.4 ± 15.8. Univariate and multivariate analyses were performed to identify parameters associated with failure of embolization, need for additional surgery to control bleeding, and fatal outcome at 30 d.

Results

Embolization was technically successful in 35 of 36 patients (97.2%) and resulted in immediate and sustained (> 24 h) hemodynamic improvement in 29 (80.5%). Additional hemostatic surgery was necessary after embolization in six patients (16.6%). Fifteen patients (41.6%) died within 30 d. Failure to restore hemodynamic stability was correlated with the rate of administration of packed red blood cells (P = .014), rate of administration of fresh frozen plasma (FFP; P = .031), and systolic blood pressure (SBP) immediately before embolization (P = .002). The need for additional surgery was correlated with FFP administration rate before embolization (P = .0002) and hemodynamic success (P = .003). Death was correlated with Glasgow Coma Scale score at admission (P = .001), ISS (P = .014), New Injury Severity Score (P = .016), number of injured sites (P = .012), SBP before embolization (P = .042), need for vasopressive drugs before embolization (P = .037), and hemodynamic success (P = .0004).

Conclusions

In patients in hemodynamically unstable condition, transcatheter arterial embolization effectively controls bleeding and improves hemodynamic stability. Immediate survival is related to hemodynamic condition before embolization, and 30-d mortality is mainly related to associated brain trauma.

Section snippets

Materials and Methods

This retrospective study was approved by the local ethics committee, and a waiver for informed consent was obtained. Clinical and radiologic data were reviewed retrospectively from a prospective trauma registry, radiologic reports, and patient hospital charts. Relevant data were entered into a database on FileMaker Pro 9 software (FileMaker, Santa Clara, California).

Inclusion criteria were the following: polytrauma with hemodynamic instability, multiple bleeding sites, and treatment with

Results

The mean Injury Severity Score (ISS) was 49.4 ± 15.8. The mean New Injury Severity Score (NISS) was 50.6 ± 16. Active bleeding sites for each patient are shown in Table 2. The hemodynamic condition of patients at admission and at the time of transcatheter arterial embolization, as well as their outcomes, are shown in Table 3. Eight patients were receiving vasoactive drugs, with a mean norepinephrine dose of 26 μg/min.

Two patients required surgery before undergoing multidetector CT because of

Discussion

The present study was performed to evaluate the feasibility and outcomes of transcatheter arterial embolization in severely injured patients in hemodynamically unstable condition with polytraumatic injuries that included retroperitoneal bleeding associated with intrabdominal solid-organ injuries. Hemodynamic stabilization was achieved with transcatheter arterial embolization in 29 of 36 patients (80.5%). Additional hemostatic surgery had to be performed before or immediately after embolization

Acknowledgments

The authors thank Philippe Frascarolo for statistical analysis and advice.

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    None of the authors have identified a conflict of interest.

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