A 56-year-old female fell from 4m height while working on a roof. Her Glasgow Coma Scale (GCS) score was 15 on admission. She presented with hypotension secondary to severe pelvic fracture. During fluid resuscitation her conscious level deteriorated to a GCS score of 6 accompanied by right pupil dilation. Due to persistent hemonhagic shock, we inserted an intra-aortic balloon occluder (IABO) via the left femoral artery. Blood pressure control was attained immediately after insertion of the IABO. Head CT scan revealed a right acute epidural hematoma without evidence of perimesncephalic cistern involvement. In the ER, emergency burr hole surgery was performed to evacuate the hematoma. The patient's conscious level improved to a GCS score of 8 and right pupillary size returned to normal. Subsequently, we performed interventional embolization and hemostasis was achieved. 24 days after admission, the patient was transferred to a nearby hospital without evidence of neurological deficits. We found that IABO was useful for controlling hemorrhagic shock due to severe pelvic fracture. Consequently, it was possible to evaluate and treat the patient's head injury, which was associated with severe consciousness disturbance and signs of impending herniation such as anisocoria and Cushing phenomenon.
