From the Guidelines
Yes, a cold pack can help shrink a hematoma.
Rationale
- The use of cold packs has been shown to aid in hemostasis, with very-low-quality evidence from a 2015 RCT 1 suggesting a benefit in reducing femoral hematoma formation in post-PCI patients.
- This study found a statistically significant reduction in hematoma formation, with an illustration indicating a reduction in hematoma size by approximately 20 cm2 over 180 minutes in the cold compression group.
- A treatment recommendation from the same year suggests that localized cold therapy with or without pressure may be beneficial in hemostasis for closed bleeding in extremities, although this is based on very-low-quality evidence 2.
- While there is inadequate evidence to make a treatment recommendation concerning the use of localized cold therapy for external bleeding 3, the available evidence suggests that cold packs may be beneficial in shrinking hematomas, particularly in the context of closed bleeding in extremities.
From the Research
Effect of Cold Pack on Hematoma
- The application of a cold pack can reduce the formation of hematomas, as shown in a study published in the International Journal of Nursing Sciences 4.
- A randomized controlled trial published in Heart & Lung: The Journal of Critical Care found that cold-pack therapy was more effective in reducing the size of femoral hematomas compared to sandbag compression 5.
- The reduction in hematoma size is likely due to the vasoconstrictive effect of cold temperatures, which can help reduce bleeding and promote hemostasis.
Mechanism of Action
- Cold pack therapy produces significant temperature falls in cutaneous and subcutaneous superficial tissues, without directly changing the temperature of tissues at or more than 2.0 cm below the skin 6.
- The temperature gradients of both layers of tissue reverse after treatment, indicating that the deep tissue beneath is at least one of the sources of heat used to rewarm the cooled superficial tissue 6.
Clinical Implications
- The use of cold packs may be beneficial in reducing hematoma formation and promoting hemostasis in patients undergoing percutaneous coronary intervention 4, 5.
- However, the application of ice or cold packs may not be suitable for all patients, such as those with hemophilia, as it may impair coagulation and prolong bleeding 7.