A ruptured abdominal aortic aneurysm that requires preoperative cardiopulmonary resuscitation is not necessarily lethal

Abstract

An RAAA that requires preoperative CPR is not necessarily a lethal combination. Patient selection must be tailored before surgery is denied.

Repair of ruptured abdominal aortic aneurysm after cardiac arrest

“…In the analysis of rAAA by Davidovi c et al, 3 35 of 38 patients with preoperative cardiac arrest died: 15 (43%) deaths were intraoperative, whereas 20 (57%) occurred postoperatively within 30 days of repair. Similarly, among the 13 patients with preoperative cardiac arrest who underwent aortic repair in the series by Broos et al, 18 eight (62%) died. Of these, four (50%) died intraoperatively, whereas the remainder died between 1 and 20 days postoperatively.…”

“…After systematic database searches and removal of duplicate records, 7210 citations were screened (Fig) . Sixty-two publications were eligible for review, of which 16 reported management and outcomes for patients with preoperative cardiac arrest (Table II). 3,[5][6][7][8][9][10][11][12][13][14]18,[23][24][25] Thirteen articles were single institution series, whereas three were multi-center or database studies. All were retrospective, Oxford level of evidence IV studies.…”

“…7,14 However, as an isolated risk factor, cardiac arrest is poorly predictive of survival after aortic repair. 1,3,11,12,16,17 Indeed, several series have reported mortality rates of around 75%, 10,11,18 which includes survivors achieving good long-term functional outcomes. 18 As such, the prognostic implications of preoperative cardiac arrest among patients with rAAA remain controversial.…”

“…1,3,11,12,16,17 Indeed, several series have reported mortality rates of around 75%, 10,11,18 which includes survivors achieving good long-term functional outcomes. 18 As such, the prognostic implications of preoperative cardiac arrest among patients with rAAA remain controversial. The decision to intervene in the setting of cardiac arrest becomes more important as the use of endovascular aortic repair (EVAR) for rAAA is expanded, particularly for hemodynamically unstable patients in which aortic balloon occlusion can enable rapid control of hemorrhage during active resuscitation.…”

¿Las sociedades profesionales deberían abstenerse de la autoría de directrices y de declaraciones de definición de enfermedad (guías clínicas)?

“…Un punto controvertido en el manejo de un AAAr es la necesidad de RCP. Si bien es cierto que en este subgrupo de pacientes la mortalidad puede acercarse al 100 %, un estudio multicéntrico reciente ha mostrado que la mortalidad en pacientes que requieren RCP, a priori de pronóstico infausto, es equivalente a la del resto (45). Este hallazgo choca con la afirmación que aparece en las guías NICE de que la insignificante probabilidad de supervivencia en caso de parada cardíaca y/o pérdida de consciencia persistente debería limitar el tratamiento al final de la vida (27).…”