Pre-peritoneal balloon tamponade for lethal closed retroperitoneal hemorrhage in a swine model: A comparable and minimally invasive alternative to open pre-peritoneal packing.

BACKGROUND: The management of massive pelvic fracture-associated hemorrhage is extremely challenging, particularly in the unstable patient. We sought to characterize and compare the efficacy of a minimally-invasive pre-peritoneal balloon technique (MIB) to standard open packing. METHODS: Twenty-six swine were randomized to control (C), OP, and MIB groups. A closed extraperitoneal iliac vascular injury followed by intervention+resuscitation over a 120 min. OP and MIB efficacy was assessed by procedure time, hemodynamics (HD), extraperitoneal tamponade pressures (ETP), blood loss, and survival. Angiography was performed in select animals and ETPs were also measured in humans undergoing MIB placement for an elective procedure. RESULTS: Baseline parameters (MAP [29, 38, 38 mmHg], cardiac index [3.5, 3.8, 4.2], and ETPs [5, 4, 5 mmHg]) were similar among C, OP, and MIB groups respectively (all P>0.05). OP and MIB groups had markedly improved MAP and CI versus C. The MIB generated significantly higher ETP (28 vs 17 mmHg), was faster to deploy (164 vs 497 sec), and had lower total blood loss versus OP (0.7 vs 1.2L, all p

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