Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
Department of Research and Development, Prehospital Emergency Medical Service, Central Denmark Region, Aarhus, Denmark.
Acta Anaesthesiol Scand. 2024 May;68(5):693-701. doi: 10.1111/aas.14393. Epub 2024 Feb 28.
Patients with ruptured abdominal aortic aneurysm (rAAA) require immediate vascular treatment to survive. The use of prehospital point-of-care ultrasound (POCUS) may support clinical assessment, correct diagnosis, appropriate triage and reduce system delay. The aim was to study the process of care and outcome in patients receiving prehospital POCUS versus patients not receiving prehospital POCUS in patients with rAAA, ruptured iliac aneurysm or impending aortic rupture.
We performed a retrospective cohort study in patients diagnosed with rAAA in the Central Denmark Region treated by a prehospital critical care physician from 1 January 2017 to 31 December 2021. Performance of prehospital POCUS was extracted from the prehospital electronic health records. System delay was defined as the time from the emergency phone call to the emergency medical service dispatch centre until the start of surgery. Data on patients primary hospital admission to a centre with/without vascular treatment expertise, treatments and complications including death were extracted from electronic health records.
We included 169 patients; prehospital POCUS was performed in 124 patients (73%). Emergency surgical treatment was performed in 71 patients. The overall survival in the POCUS group was 39% versus 16% in the NO POCUS group (hazard ratio (HR) (95% 0.60, 95% CI: 0.41-0.89, p = .011). In the POCUS group 99/124 (80%) were directly admitted to a vascular surgical centre versus 25/45 (56%) in the NO POCUS, RD 24% (95% CI: 8-40)), (p = .002). In the POCUS group, system delay was a median of 142 minutes (interquartile range (IQR) 121-189) and a median of 232 minutes (IQR 166-305) in the NO POCUS group (p = .006). In a multivariable analysis incorporating age, sex, previously known rAAA, and typical clinical symptoms of rAAA, the HR for death was 0.57, 95% CI 0.38-0.86 (p = .008) favouring prehospital POCUS.
Prehospital POCUS was associated with reduced time to treatment, higher chance of operability and significantly higher 30-day survival in patients with rAAA, ruptured iliac aneurysm or impending rupture of an AAA in this retrospective study. Residual confounding cannot be excluded. This study supports the clinical relevance of prehospital POCUS of the abdominal aorta.
患有破裂性腹主动脉瘤（rAAA）的患者需要立即进行血管治疗才能存活。在院前使用即时护理超声（POCUS）可能有助于临床评估、正确诊断、适当分诊和减少系统延迟。目的是研究在 rAAA、破裂性髂动脉瘤或即将破裂的主动脉瘤患者中，接受院前 POCUS 与未接受院前 POCUS 的患者的护理过程和结局。
我们对 2017 年 1 月 1 日至 2021 年 12 月 31 日期间在丹麦中部地区被院前重症监护医生诊断为 rAAA 的患者进行了回顾性队列研究。从院前电子健康记录中提取院前 POCUS 的实施情况。系统延迟定义为从紧急电话到紧急医疗服务调度中心的时间与手术开始的时间之间的时间。从电子健康记录中提取了患者首次入院至有/无血管治疗专业知识的中心、治疗和并发症（包括死亡）的数据。
我们纳入了 169 名患者；在 124 名患者（73%）中进行了院前 POCUS。对 71 名患者进行了紧急手术治疗。在 POCUS 组中，整体生存率为 39%，而在无 POCUS 组中为 16%（风险比（HR）（95%CI：0.41-0.89，p=0.011）。在 POCUS 组中，99/124（80%）直接入院到血管外科中心，而在无 POCUS 组中，25/45（56%）入院，RD 24%（95%CI：8-40），（p=0.002）。在 POCUS 组中，系统延迟中位数为 142 分钟（IQR 121-189），在无 POCUS 组中为 232 分钟（IQR 166-305）（p=0.006）。在包含年龄、性别、先前已知的 rAAA 和 rAAA 典型临床症状的多变量分析中，POCUS 组的死亡风险比为 0.57，95%CI 0.38-0.86（p=0.008），这有利于院前 POCUS。
在这项回顾性研究中，在患有 rAAA、破裂性髂动脉瘤或即将破裂的主动脉瘤的患者中，院前 POCUS 与治疗时间缩短、更高的可操作性和显著提高的 30 天生存率相关。不能排除残留的混杂因素。这项研究支持院前腹部主动脉 POCUS 的临床相关性。
