Acute Type A Aortic Dissection With Cardiopulmonary Arrest at Presentation

Nakai, Chikashi; Izumi, Shigeki; Haraguchi, Tomonori; Kikuta, Shota; Nakayama, Shinichi; Okita, Yutaka; Tsukube, Takuro

doi:10.1016/j.athoracsur.2020.11.007

Cited by 16 publications

(13 citation statements)

References 17 publications

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“…When patients do arrest in the setting of ATAAD, there is still great uncertainty over how to proceed. The studies 29,[33][34][35] cited above found that a subset of this overall patient population, who had ROSC and underwent aortic repair, had improved chances of survival. For aortic repair, CPB should be promptly established by femoral artery cannulation and/or central cannulation and central venous drainage after immediate median sternotomy.…”

Section: Approachesmentioning

confidence: 91%

“…26 Approximately 7% of all patients with out-of-hospital CPA were diagnosed with ATAAD. [27][28][29] Meron et al 30 reported that the mortality rate from cardiac arrest caused by aortic dissection remained high even when circulation was initially restored. In their study, 29% of patients with CPA caused by dissection or rupture of the thoracic aorta achieved a return to spontaneous circulation (ROSC), and one patient survived.…”

Section: Epidemiology and Clinical Presentationmentioning

confidence: 99%

“…Given recent advances in rapid medical transportation and early diagnosis system using echocardiography and CT, and the introduction of extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO), the number of ATAAD patients with CPA has been increasing. 29…”

Section: Epidemiology and Clinical Presentationmentioning

confidence: 99%

“…They concluded that the surgery outcomes were still reasonable in ATAAD patients requiring preoperative CPR in a high-volume center. Recently, Nakai et al 29 reported that of 2974 patients of CPA transported to their hospital, 157 (5.3%) were diagnosed with ATAAD. The causes of CPA included cardiac tamponade in 75%, hemothorax in 10%, and coronary malperfusion in 10%.…”

Section: Outcomes Of Aortic Repairmentioning

confidence: 99%

“…For brain protection, moderate or deep hypothermia with ACP has been recommended. 29,34,35 For myocardial protection, RCP after the establishment of CPB is mostly selected. And, the life-saving surgery with hemi- or partial arch replacement has been primarily selected.…”

Section: Ataad Presenting With Cpamentioning

confidence: 99%

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Decision making and management of acute type-A dissection presenting with shock or cardiac arrest

Tsukube

2022

Asian Cardiovasc Thorac Ann

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While the outcome of aortic repair for acute type-A aortic dissection has improved, overall mortality among patients who developed acute type-A aortic dissection remains extremely high. Hypotension in acute type-A aortic dissection patients is a critical condition that is associated with increased in-hospital mortality and neurologic events. The underlying causes of shock include acute aortic regurgitation, cardiac tamponade, and myocardial infarction. The most reasonable initial approach is to administer intravenous fluids to improve blood pressure, increase preload and cardiac output, and ensure adequate end-organ perfusion. Cardiac tamponade-induced hypotension associated with aortic rupture has been identified as a major risk factor for perioperative mortality in patients with acute type-A aortic dissection. In addition, the most serious complications of acute type-A aortic dissection include preoperative cardiopulmonary arrest, especially out-of-hospital cardiopulmonary arrest. Recent advances in rapid transportation and diagnosis, and the introduction of extracorporeal cardiopulmonary resuscitation, have resulted in an increase in the number of patients with cardiopulmonary arrest related to acute type-A aortic dissection. However, controversy continues to surround treatment strategies, surgical indications, and the timing of surgery on such patients. This review, therefore, discusses decision-making and the managerial issues surrounding acute type-A dissection presenting with shock, cardiac tamponade, and cardiac arrest

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Section: Approachesmentioning

confidence: 91%