Emergency Hemorrhage Control Strategies and Outcomes in Hemodynamically Unstable Pelvic Fracture Trauma: A Systematic Review.

OBJECTIVES: This systematic review aimed to evaluate and compare emergency hemorrhage control interventions for hemodynamically unstable pelvic fracture trauma, assessing clinical outcomes, including mortality, transfusion requirements, and complication rates. METHODS: A comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar was conducted in December 2024. Studies were selected based on predefined inclusion criteria, which considered adult patients (≥18 years) with hemodynamically unstable pelvic fractures. Data extraction and quality assessment were performed using standardized tools. Interventions of interest included preperitoneal pelvic packing (PPP), angioembolization (AE), resuscitative endovascular balloon occlusion of the aorta (REBOA), and mechanical stabilization. RESULTS: Ten studies were included. PPP and AE demonstrated comparable in-hospital mortality rates. However, PPP was associated with shorter intervention times and reduced early transfusion requirements. Mechanical stabilization was universally recommended as an initial step, while REBOA served as a temporizing measure. The overall strength of evidence was moderate, derived primarily from retrospective studies and meta-analyses, with no randomized controlled trials identified. CONCLUSION: Both PP and AE were effective for hemorrhage control in hemodynamically unstable pelvic fractures, with the choice of first-line intervention often dependent on logistical factors. The development of standardized protocols and prospective studies should be prioritized in future work to optimize management strategies.