Author + information
- Chad Raymond,
- Jessen Jacob,
- Bhuvnesh Aggarwal,
- Damon Kralovic,
- David Holloway,
- Eric Roselli and
- Venu Menon
Acute type A dissection (TAD) is a time sensitive emergency that requires emergent surgical intervention. Unlike established door to balloon and door in door out times with STEMI, no established guidelines exist for the transfer or definitive treatment for patients with TAD. The availability of these metrics will facilitate the creation and organization of Acute Aortic Syndrome networks to mimick STEMI programs. We sought to analyze outcomes based on door-OR time in a consecutive series of patients with established TAD.
104 consecutive patients with confirmed acute type A aortic dissection were transferred by the Cleveland Clinic Critical Care Transport team utilizing helicopter (n=84), ground ambulance (n=14) or fixed wing jet (n=6) directly to our CICU between March 2010 to June 2012. Time from arrival to the CICU to start of case by anaesthesia (door-OR time) was abstracted.
The mean age was 63 ± 15 years and 63% were male. Patients were transferred from 53 different hospitals with a median travel distance of 42 miles (IQR =15-82). Prior to transfer incidence of hypotension, shock, or cardiac arrest was 17.3%. Median transfer time (transport team dispatch to arrival at tertiary center CICU) was 85 minutes (IQR = 64-117) and transport team door-in-door-out time was 24 minutes (IQR = 18-32). Overall 87 (83.6%) patients received aortic surgery with a median door-OR time of 2.2 hours (IQR = 1-10). Door-OR time was 0-2 hours in 36, 2-4 hours in 18, 4-6 hours in 6 and >6 hours in 26 subjects respectively. The overall in hospital surgical mortality was 3/87 (3.5%) with all surgical deaths in the 0-2 hour window. The cohort in-hospital mortality was 12/104 (11.5%).
In a consecutive transfer series utilizing a critical care transport team, overall surgical mortality for a series of TAD was excellent. Amongst patients taken to surgery, no time related threshold for outcome was identified.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Aortic, Peripheral Vascular and Non-Cardiac Conditions
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1159-110
- 2013 American College of Cardiology Foundation