Results of streamlined regional ambulance transport and subsequent treatment of acute abdominal aortic aneurysms

• Published in: Emergency medicine journal : EMJ 2006-10, Vol.23 (10), p.807-810
• Main Authors: Haveman, J W, Karliczek, A, Verhoeven, E L G, Tielliu, I F J, de Vos, R, Zwaveling, J H, van den Dungen, J J A M, Zeebregts, C J, Nijsten, M W N
• Format: Article
• Language: English
• Subjects: AAA; abdominal aortic aneurysm; Acute Disease; Aged; Ambulances - standards; Aneurysms; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - surgery; Emergencies; Emergency medical care; Emergency Service, Hospital; Epidemiologic Methods; Female; Humans; ICU; intensive care unit; Length of Stay - statistics & numerical data; Male; Middle Aged; Mortality; Netherlands; non-ruptured abdominal aortic aneurysm; Postoperative period; Prehospital Care; rAAA; ruptured abdominal aortic aneurysm; sAAA; symptomatic; Time Factors; Treatment Outcome; Triage - methods
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emj.2006.037879

Objective: To describe the triage of patients operated for non-ruptured and ruptured abdominal aortic aneurysms (AAAs) before the endovascular era. Design: Retrospective single-centre cohort study. Methods: All patients treated for an acute AAA between 1998 and 2001 and admitted to our hospital were evaluated in the emergency department for urgent AAA surgery. All time intervals, from the telephone call from the patient to the ambulance department, to the arrival of the patient in the operating theatre, were analysed. Intraoperative, hospital and 1-year survival were determined. Results: 160 patients with an acute AAA were transported to our hospital. Mean (SD) age was 71 (8) years, and 138 (86%) were men. 34 (21%) of these patients had symptomatic, non-ruptured AAA (sAAA) and 126 patients had ruptured AAA (rAAA). All patients with sAAA and 98% of patients with rAAA were operated upon. For the patients with rAAA, median time from telephone call to arrival at the hospital was 43 min (interquartile range 33–53 min) and median time from arrival at the hospital to arrival at the operating room was 25 min (interquartile range 11–50 min). Intraoperative mortality was 0% for sAAA and 11% for rAAA (p = 0.042), and hospital mortality was 12% and 33%, respectively (p = 0.014). Conclusions: A multidisciplinary unified strategy resulted in a rapid throughput of patients with acute AAA. Rapid transport, diagnosis and surgery resulted in favourable hospital mortality. Despite the fact that nearly all the patients were operated upon, survival was favourable compared with published data.