Instabilità emodinamica nelle fratture del bacino: efficacia e complicanze dell’utilizzo precoce dei Pelvic Circumferential Compression Devices. Revisione della letteratura

Luca Padoan, Nicola Bortoli, Pierluigi Badon, Federico Pellegatta, Marta Canesi, Alessandro Monterosso, Sara Buchini

Abstract

Introduzione. Le lesioni dell’anello pelvico risultano essere letali a causa delle emorragie associate e per tale motivo è fondamentale una gestione precoce. Essendo i Pelvic Circumferential Compression Devices (PCCDs) dispositivi piuttosto recenti, l’obiettivo di questa revisione della letteratura è quello di indagare la loro efficacia e le possibili complicanze.
Materiali e metodi. La ricerca è stata effettuata sui database Medline, The Cochrane Library, CINAHL, Embase e Scopus, includendo gli articoli pubblicati in lingua inglese e italiana negli ultimi 10 anni.
Risultati. Sono stati analizzati 29 articoli: 17 indagano l’efficacia dei PCCDs, 5 mettono a confronto i vari dispositivi, 3 studiano le modalità di posizionamento e 4 evidenziano le complicanze associate a questi presidi.
Discussione. I PCCDs sono efficaci nel ridurre il volume pelvico nelle fratture e spesso anche il sanguinamento conseguente stabilizzando i pazienti emodinamicamente compromessi. Il T-POD® e il SAM SlingTM sono i presidi maggiormente supportati dalle evidenze, che suggeriscono inoltre il posizionamento sulla linea del grande trocantere del femore, a contatto con la cute. Le principali complicanze emerse sono le lesioni da pressione qualora il dispositivo rimanga posizionato a lungo.
Conclusioni. Sebbene non sia stata dimostrata l’efficacia nella riduzione della mortalità e delle emotrasfusioni, l’utilizzo di questi dispositivi è raccomandato ogni qualvolta si sospetti una lesione della pelvi al fine di contenere il sanguinamento. Per ovviare all’insorgenza di complicanze, devono essere rimossi non appena risulta possibile la stabilizzazione invasiva del bacino.

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