Surgical outcomes of acute type A aortic dissection in patients undergoing cardiopulmonary resuscitation |
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| Authors: | Kyokun Uehara Hitoshi Matsuda Jiro Matsuo Yosuke Inoue Takayuki Shijo Atsushi Omura Yoshimasa Seike Hiroaki Sasaki Junjiro Kobayashi |
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| Affiliation: | 1. Division of Nephrology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo;2. Division of Critical Care, Department of Medicine, Washington University, St Louis, Mo;3. Adult and Child Consortium for Health Outcomes Research and Delivery Science and Surgical Outcomes and Applied Research, University of Colorado, Aurora, Colo;4. Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo;5. Rocky Mountain Regional VA Medical Center, Aurora, Colo;1. Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio;2. Department of Anesthesiology, Temple University, Philadelphia, Pa;3. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio;1. Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;2. Netherlands Heart Registry, Utrecht, The Netherlands;3. Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands;4. Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands;5. Department of Cardiothoracic Surgery, Isala, Zwolle, The Netherlands;6. Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;7. Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;8. Department of Intensive Care, University of Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands;1. Center for Basic Medical Research and Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China;2. Department of Cardiac Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, China;3. School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China;4. Department of Surgery, Oregon Health and Science University, Portland, Ore;1. Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill;2. Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, Ill |
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| Abstract: | ObjectivesThe surgical indications for acute type A aortic dissection (AAAD) in patients in cardiopulmonary arrest remain controversial. Outcomes of AAAD for patients who underwent cardiopulmonary resuscitation (CPR) were evaluated.MethodsBetween 2004 and 2018, of the 519 patients who underwent AAAD repair, 34 (6.6%) required CPR before or on starting AAAD repair. The patients were divided into 2 groups, survivors (n = 13) and nonsurvivors (n = 21), to compare the early operative outcomes, including mortality and neurological events.ResultsThe major cause of cardiovascular collapse requiring CPR was aortic rupture/cardiac tamponade (n = 21 [61.8%]), followed by coronary malperfusion (n = 12 [35.3%]) and acute aortic valve regurgitation (n = 3 [8.8%]). There were 3 (23.1%) patients in the survivors group and 11 (52.4%) in the nonsurvivors group who required ongoing CPR at the beginning of AAAD repair (P = .039). Of these patients, 1 survivor and 6 nonsurvivors could not achieve return of spontaneous circulation after pericardiotomy (P = .045). Although the duration from onset or arrival to the operating room was similar (P = .35 and P = .49, respectively), overall duration of CPR was shorter in survivors (10 minutes [range, 7.5-16 minutes] vs 16.5 minutes [range, 15-20 minutes]; P = .044). All survivors without any neurological deficits showed return of spontaneous circulation after pericardiotomy. Multivariate regression modeling showed that CPR duration >15 minutes was a significant risk factor for in-hospital mortality (P = .0040).ConclusionsCPR duration beyond 15 minutes may be a contraindication for AAAD repair. Moreover, we should reconsider surgery for patients who cannot achieve return of spontaneous circulation after pericardiotomy. |
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