Inadequate hemodynamic management in patients undergoing interfacility transfer for suspected aortic dissection

• Published in: The American journal of emergency medicine 2005, Vol.23 (1), p.24-29
• Main Authors: Winsor, Greg, Thomas, Stephen H., Biddinger, Paul D., Wedel, Suzanne K.
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Aged, 80 and over; Analgesics; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - physiopathology; Aneurysm, Dissecting - therapy; Antihypertensive Agents - therapeutic use; Aortic Aneurysm - diagnosis; Aortic Aneurysm - physiopathology; Aortic Aneurysm - therapy; Biological and medical sciences; Blood Pressure; Clinical death. Palliative care. Organ gift and preservation; Confidence intervals; Critical Care - methods; Critical Care - statistics & numerical data; Design; Dissection; Emergency medical care; Emergency medical services; Female; Heart Rate; Hospitals; Humans; Intensive care medicine; Intubation; Male; Medical imaging; Medical sciences; Middle Aged; Neuropharmacology; Outcome and Process Assessment (Health Care); Patient Transfer - methods; Patient Transfer - statistics & numerical data; Pharmacology. Drug treatments; Quality of Health Care - statistics & numerical data; Retrospective Studies
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2004.01.008

The study goal was the analysis of effectiveness of hemodynamic management of patients undergoing interfacility transport for suspected acute aortic dissection (SAAD). Our retrospective, consecutive-case review examined 62 nonhypotensive patients transported by an air emergency medical services (EMS) service during 1998 to 2002, with referral hospital diagnosis of SAAD. Of patients with systolic blood pressure (SBP) less than 120 upon air EMS arrival, antihypertensives had been given in only 23/42 (54.8%). In 19 cases where pretransport SBP is less than 120, with no referral hospital antihypertensive therapy given, median pretransport SBP was 158 (range, 122-212). In 20/62 cases (32.3%), the air EMS agency instituted antihypertensive therapy, which was successful; of 42 cases with pretransport SBP less than 120, mean intratransport SBP decrement was 24 (95% confidence interval, 16-32). In patients undergoing transport for SAAD, pretransport hemodynamic therapy was frequently omitted and often inadequate, generating an opportunity for air EMS intervention. Education to improve SAAD care should focus upon both referral hospitals and transport services.