Characteristics of patients that experience cardiopulmonary arrest following aortic dissection and aneurysm

Abstract

Aim:The aim of this study is to investigate the characteristics of patients experience cardiopulmonary arrest (CPA) in the acute phase following aortic dissection and aneurysm (AD).Materials and Methods:Patients who were transported to this department from January 2005 to December 2010 and subsequently diagnosed with AD were included in this study. Patients with asymptomatic AD or those with AD that did not develop CPA were excluded. The AD was classified into four categories: Stanford A (SA), Stanford B (SB), thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). The frequency of witnessed collapse, gender, average age, past history including hypertension, vascular complications and diabetes mellitus, the initial complaint at the timed of dissection, initial electrocardiogram at scene, classification of CPA and survival ratio were compared among the patient groups.Results:There were 24 cases of SA, 1 case of the SB, 8 cases of ruptured TAA and 9 cases of ruptured AAA. The frequency of males among all subjects was 69%, the average age was 72.3 years old and the frequency of hypertension was 47.6%. There was no ventricular fibrillation (VF) when the patients with AD collapsed. A loss of consciousness was the most common complaint. The outcome of the subjects was poor; however, three patients with SA achieved social rehabilitation. Two out of the three had cardiac tamponade and underwent open heart massage.Conclusion:The current study revealed that mortality of cardiac arrest caused by the AD remains very high, even when return of spontaneous circulation was obtained. VF was rare when the patients with AD collapsed. While some cases with CPA of SA may achieve a favorable outcome following immediate appropriate treatment.

Decision making and management of acute type-A dissection presenting with shock or cardiac arrest

“…Kurimoto et al 31 reported that one patient with out-of-hospital CPA after ROSC underwent aortic repair and survived without neurological sequelae. Yanagawa et al 32 reported that the survival rate among 24 patients with CPA at presentation caused by ATAAD was 13%, and only one patient underwent surgical treatment. Given recent advances in rapid medical transportation and early diagnosis system using echocardiography and CT, and the introduction of extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO), the number of ATAAD patients with CPA has been increasing.…”

A Case in Which Focal Convulsion Was the Initial Sign of Fatal Aortic Dissection

“…However, AD can be painless and lead to various symptoms, such as hoarseness, heart failure, syncope, stroke, paraplegia, anuria, or sudden death. 1,2 We, herein, present the case of a patient with acute aortic dissection Type A whose initial complaint was focal convulsion.…”