CRRT during TAE in Unstable Pelvic Fracture with Severe Lactic Acidosis

Abstract

A 60-year-old male presented to the emergency department at midnight through referral by another hospital, where he underwent transcatheter arterial embolization (TAE) for pelvic bleeding that developed after falling from a height of 9 m. The patient’s vital signs were as follows: systolic blood pressure, 70 mm Hg; pulse rate, 128 beats/min; respiration rate, 40 breaths/min; body temperature, 36.3°C; and oxygen saturation, 89%. Accordingly, immediate intubation and mechanical ventilation were performed. His initial arterial blood gas analysis (ABGA) revealed a pH of 6.99, HCO3− of 10.8, lactic acid profile of 13.5 mmol/L, and a base excess of −19.6. Abdominal CT after fluid resuscitation demonstrated an unstable pelvic ring fracture (Fig. 1.). The patient was therefore suspected of hemorrhagic shock caused by persistent bleeding from the blood vessels in the pelvis. Therefore, we decided to perform TAE for hemorrhage control. Priming of the continuous renal replacement therapy (CRRT) was conducted during the interventional radiologist’s visit to the hospital. A catheter was inserted via the left femoral vein in the intervention room immediately before Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298