Bruna F, Lecherbonnier A, Belle L, Vallenet C, Chavanon O, Chavanis N
Service de réanimation, centre hospitalier Alpes-Léman, 558, route de Findrol, 74130 Contamine-sur-Arve, France.
Urgences, centre hospitalier universitaire Grenoble, avenue Maquis du Grésivaudan, 38700 La Tronche, France.
Ann Cardiol Angeiol (Paris). 2020 May;69(3):120-124. doi: 10.1016/j.ancard.2020.03.005. Epub 2020 Apr 8.
To assess the diagnostic delay (between first hospital medical contact and diagnosis) and the surgical delay (between diagnosis and incision) of type A acute aortic syndromes (AAAS) within the RENAU (REseau Nord Alpin des Urgences), organizing the management of emergency medicine care in the French North Alpine Arc.
Multicenter retrospective study between 2012 and 2016 on the AAAS operated in the RENAU heart surgical centers (Annecy, Grenoble). Post-traumatic, iatrogenic or chronic lesions, incidental discoveries and deaths before surgery were excluded.
One hundred and ninety-seven patients were included with a median age [IQR] of 65 years [58; 73] of which 67% were men. The median diagnosis delay was 88min [46;241] and the median surgical delay was 193min [146;249]. Initial management was performed by the SMUR for 102 patients (52%), 7% of whom received a pre-hospital transthoracic ultrasound. 52 patients (26%) presented themselves spontaneously to the emergency department. Patients were initially admitted in a center without cardiac surgery in 65% of cases. The CT scan was the diagnostic test in 81% of cases. The postoperative hospital mortality was 16%.
Referring to IRAD data reporting a median diagnostic and surgical delay of 258min each, our study suggests that the RENAU organization may be associated with reduced diagnostic and surgical delays for patients with SAAA.
