A retrospective observational study assessing mortality after pelvic trauma embolisation

Bladder inflation to reduce hemorrhage secondary to a pelvic fracture

Bladder inflation may be a temporizing measure to tamponade pelvic bleeding in select trauma cases to bridge the patient to definitive interventions. Ultrasonographic confirmation of an intact bladder with an adjacent pelvic haematoma in a shocked adult with pelvic fracture is used for subject selection. An illustrative example of physiologic and interventional radiological control of pelvic bleeding following bladder inflation with sterile saline is presented.

Let us settle the controversy-gelfoam is a safe intravascular embolic agent

OBJECTIVES

A 2021 safety alert restricted endovascular gelfoam use in Australia and resulted in an embargo on gelfoam sales to Interventional Radiology departments. This study aimed to show that gelfoam is safe in a population of trauma patients with pelvic injury, and discuss the basis of the recent controversies.

METHODS

Retrospective cohort study was conducted between 1 January 2010 and 21 May 2021 for the patients who underwent gelfoam embolization for pelvic arterial haemorrhage. Primary outcome was the rate of adverse events related to intravascular gelfoam administration.

RESULTS

Inclusion criteria met in 50 patients, comprising 58% males median age 59.9 years, and median injury severity score 31. There were 0 complications related to gelfoam use and 100% technical success. Thirty-five patients (70%) received a non-targeted embolization approach. All-cause mortality was observed in 5 patients (10%), unrelated to gelfoam.

CONCLUSIONS

Gelfoam is a safe and effective embolic agent in pelvic trauma. Patients are in urgent need of universal on-label registration of endovascular gelfoam products, as it is life-saving in major haemorrhage after trauma.

ADVANCES IN KNOWLEDGE

Endovascular gelfoam is mandatory for a high-quality trauma service, and this study shows that it is safe to use intentionally in the endovascular space. Companies should work with interventional radiologists, sharing and collaborating to ensure positive outcomes for patients.