Foley Catheter Following Penetrating Neck Trauma. A Definitive Therapy to Stop the Bleeding?

Abstract

Introduction: The incidence of penetrating neck injuries is experiencing an upward trend. Given that hemorrhaging stands as one of the most preventable causes of fatality in traumatic situations, the prospect of employing a foley catheter (FC) to manage bleeding following penetrating neck injuries has led to contemplation on its integration into standardized protocols for bleeding control (BC), both in prehospital and in-hospital settings. Furthermore, inquiries into establishing standardized schedules for its application have arisen. Material and Methods: A meticulous search strategy was conducted utilizing the NCBI Medical Subject Heading (MeSH) term "foley*" and various combinations such as "foley" AND "trauma"; "foley" AND "neck"; "foley" AND "penetrating"; "catheter" AND "balloon" AND "trauma"; "gunshot" AND "neck"; "hemorrhage*" AND "neck" across multiple databases. These databases include MEDLINE, PubMed, PubMed Central, Scopus, Ovid, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Additionally, comprehensive searches using these terms were performed on Google, Google Scholar, and ResearchGate. The references cited in documents retrieved from these searches, covering 1833 to 2023, were thoroughly scrutinized. Results: 15 relevant articles were identified, and pertinent data were extracted from these studies. Historically, the use of FC was confined to immediate bleeding control; however, it has now extended its application into prehospital, emergency room (ER), and intraoperative settings. The primary success rate of FC stands at n=229 out of 274 cases (84%). FC serves as a valuable tool to bridge the gap in time before reaching the ER or operating room (OR), facilitating necessary radiological studies or interventions, especially when more severe injuries necessitate prioritization. Typically, FC was retained for 24-48 hours, but instances of prolonged applications up to 240 hours have been documented. Notably, it includes the definitive management of venous neck bleeding injuries, contingent upon excluding significant arterial defects through CTA. Late rebleeding stands at a low rate of 6% (14 out of 229 cases). Conclusion: Using FC is a pertinent strategy in managing neck injuries resulting from bleeding from penetrating wounds. Its substantial primary success rate in prehospital and ER phases surpasses the success rates achieved solely through pressure or chitosan dressing. Post-primary bleeding control, the presence of FC facilitates examinations and radiological interventions. Determining the optimal duration for FC placement remains a subject for consideration, leaning toward 2-3 days, if not longer. FC is progressively solidifying its role in Selective Non-Operative Management (SNOM) for hemorrhagic penetrating neck injuries. Consequently, a Foley catheter should be an essential tool in the possession of every prehospital and ER physician. Further delineation of criteria establishing the suitability of FC placement as definitive SNOM therapy for hemorrhagic penetrating neck injuries warrants consolidation.

Keywords

• Penetrating trauma
• neck injury
• foley catheter
• balloon occlusion
• bleeding control
• observation