Outcome of Patients with Ruptured Abdominal Aortic Aneurysm after Cardiopulmonary Resuscitation

Abstract

Requirement of CPR has a detrimental effect on RAAA-patient outcome. Patients receiving CPR prior to surgery have no survival chance. We advocate that surgery in these patients should not be undertaken. Hardman Index has a predictive value concerning 30-day mortality.

Repair of ruptured abdominal aortic aneurysm after cardiac arrest

“…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.…”

“…19 Two studies concluded that aortic intervention should not be performed in patients with preoperative cardiac arrest. 8,14 In both studies, which included 290 patients with rAAA and 22 patients with cardiac arrest, mortality after cardiac arrest was 100%. In contrast, five studies endorse attempting repair in this population.…”

“…Despite dramatic changes in aortic aneurysm treatment and perioperative critical care, mortality in the setting of ruptured abdominal aortic aneurysm (rAAA) remains at approximately 50% over the past several decades. [1][2][3][4][5] Cardiac arrest occurs in up to 36% of patients surviving to hospital admission [6][7][8][9] and has been independently associated with increased postoperative mortality. 1,5,[10][11][12] Several series have reported mortality rates of 100% among patients with rAAA and preoperative arrest, 7,13,14 and clinical manifestations of advanced cardiovascular collapse, including shock, loss of consciousness, and myocardial ischemia are incorporated into rAAA severity assessment scores.…”

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

“…Two studies that reported a 100% mortality rate in preoperatively resuscitated patients advocate that invasive treatment should be denied. 7,9 In contrast, 67% and 72.8% 30-day mortality rates have been observed in patients with an RAAA that required CPR. 6,10 To our knowledge, this is the first multicenter study to describe survivors after resuscitation before RAAA surgery.…”

“…5,6 However, a slim body of low-level literature are adamant that these patients are unlikely to survive. [7][8][9] Senior authors of the present study have experienced that some patients might survive after the unfortunate combination of CPR before RAAA treatment.…”