Inflate and pack! Pelvic packing combined with REBOA deployment prevents hemorrhage related deaths in unstable pelvic fractures

•Unstable pelvic fractures managed with an algorithm using preperitoneal packing and REBOA had improved mortality.•Pelvic fractures managed with an algorithm using preperitoneal packing and REBOA had no deaths due to pelvic hemorrhage.•Preperitoneal packing with REBOA was utilized in more severely injured patients with greater physiologic derangements. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is advocated for hemorrhage control in pelvic fracture patients in shock. We evaluated REBOA in patients undergoing preperitoneal pelvic packing (PPP) for pelvic fracture-related hemorrhage. Retrospective, single-institution study of unstable pelvic fractures (hemodynamic instability despite 2 units of red blood cells (RBCs) and fracture identified on x-ray). Management included the placement of a Zone III REBOA in the emergency department (ED) for systolic blood pressure