Exsanguinating pelvis – occlude the aorta

Some patients with life-threatening arterial haemorrhage from a pelvic fracture may be peri-arrest prior to transfer to the angiography suite. French authors describe their use of a balloon catheter to occlude the infrarenal aorta to allow resuscitation to achieve sufficient stability for the transfer. As well as exsanguinating pelvic haemorrhage, intra-aortic balloon occlusion has already been described for the treatment of hemorrhagic shock in the case of ruptured abdominal aortic aneurysm, in abdominal trauma, in gastrointestinal bleeding, and in postpartum hemorrhage.
Features of note regarding the technique include:

  • it can be done blind (without radiological guidance)
  • it can be done prior to transfer to a centre with interventional radiology
  • it can be done in cardiac arrest (and has resulted in ROSC and subsequent survival)

The authors are at pains to point out that the intra-aortic balloon occlusion method described in the study ‘should be reserved to patients in critically uncontrollable hemorrhagic shock (CUHS) and is not a first-line treatment of pelvic fractures in hemorrhagic shock.’
Intra-Aortic Balloon Occlusion to Salvage Patients With Life-Threatening Hemorrhagic Shocks From Pelvic Fractures
J Trauma. 2010 Apr;68(4):942-8.