EFFECT OF THE DURATION OF SYMPTOMS, TRANSPORT TIME, AND LENGTH OF EMERGENCY ROOM STAY ON MORBIDITY AND MORTALITY IN PATIENTS WITH RUPTURED ABDOMINAL AORTIC-ANEURYSMS

Background. Despite improvements in emergency medical services, surgic al technology, and postoperative critical care, ruptured abdominal aor tic aneurysm (AAA) is associated with constantly high morbidity and mo rtality. To determine the effect of the duration of symptoms, transpor t time do hospital, and length of emergency department assessment on o utcome, we evaluated 124 consecutive patients with ruptured AAA treate d during the past decade. Methods, The medical records for 122 patient s were abstracted for preoperative hypotension, cardiopulmonary resusc itation (CPR), blood loss, and three time intervals: symptom onset to operation, transport time to hospital, and emergency department assess ment. Results, Intraoperative mortality was 26% (72 = 32), 30-day mort ality was 51% (n = 63), and cumulative hospital mortality was 56% (n = 69). Death occurred in 52 (64%) of 81 patients with hypotension compa red with 14 (35%) of 40 patients without hypotension (p less than or e qual to 0.01). Hypotension was present in 37 (82%) of 45 patients who arrived in the operating room in 2 hours or less compared with 26 (60% ) of the 43 patients who arrived later than 2 hours (p less than or eq ual to 0.05). Death followed in 21 (91%) of 23 patients who received C PR compared with 46 (46%) of 99 patients who did not receive CPR (p le ss than or equal to 0.01). Bowel ischemia was observed in 18 (30%) of 60 patients who received more than 10 units of blood compared with 3 ( 5%) of 61 patients who received 10 units or less (p less than or equal to 0.01). Conclusions. For patients with ruptured AAA, prolonged pres urgical time was associated with a more hemodynamically stable patient and a lower mortality. Progressive bleeding in those hemodynamically stable patients was reflected by a larger blood transfusion requiremen t. Such patients exhibited an increased incidence of ischemic bowel co mplications, perhaps caused by splanchnic arterial ischemia augmented by preexisting atherosclerosis, as well as extrinsic compression by me senteric hematomas.