Predictors of Angiographic Hemostasis in Life-Threatening Oronasal Hemorrhage Following Facial Trauma

Purpose:

Severe oronasal bleeding after facial trauma is uncommon, yet could be life-threatening. ^1.2 This study was aim to identify predictors of angiographic hemostasis in patients suffered from life-threatening traumatic oronasal hemorrhage.

Materials and Methods:

We retrospectively reviewed patients experienced craniofacial trauma with life-threatening oronasal hemorrhage in our institute from January 2009 to December 2014. Patients who experienced posttraumatic oronasal hemorrhage and presented with hemodynamic instability or required intubation to secure airway were enrolled.^3.4 Patients underwent angiography without contrast extravasation were excluded. The patients achieved hemostasis with transarterial embolization (TAE) were compared with the patients achieved hemostasis by conventional management. Characteristics, risk factors, mortality and morbidities, including intensive care over 10 days, neurological deficit, secondary intervention, respiratory failure, or severe infection, were collected and analyzed systemically.

Results: 
Fifty-two patients were included in this study: twelve patients reached hemostasis with conventional management, while forty patients required TAE to achieve hemostasis. The internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization. Shock index (heart rate/systolic blood pressure) among patients required TAE to achieve hemostasis was statistically significant higher than patients reached hemostasis with conventional management (p=0.0005). Among patients underwent successfully TAE, one of the patients died of severe infection. There was no sequelae or major complications after interventions. Greater morbidity is statistically related to patients required TAE for hemostasis and mortality trends to be higher in the same group.

Conclusion:

We demonstrated TAE could be an effective treatment for life-threatening oronasal bleeding among patient with severe craniofacial trauma. Initial presentation with shock index > 0.9 was a strong independent predictor of angiographic hemostasis.