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Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm.
J Vasc Surg. 2013 Apr; 57(4):943-50.JV

Abstract

OBJECTIVE

In acute traumatic bleeding, permissive arterial hypotension with delayed volume resuscitation is an established lifesaving concept as abridge to surgical control. This study investigated whether preoperatively administered volume also correlated inversely with survival after ruptured abdominal aortic aneurysm (rAAA).

METHODS

This retrospective study analyzed prospectively collected and validated data of a consecutive cohort of patients with rAAAs (January 2001 to December 2010). Generally, fluid resuscitation was guided clinically by the patient's blood pressure and consciousness. All intravenous fluids (crystalloids, colloids, and blood products) administered before aortic clamping or endovascular sealing were abstracted from paramedic and anesthesia documentation and normalized to speed of administration (liters per hour). Logistic regression modeling, adjusted for suspected confounding covariates, was used to investigate whether total volume was independently associated with risk of death within 30 days of rAAA repair.

RESULTS

A total of 248 patients with rAAAs were analyzed, of whom 237 (96%) underwent open repair. A median of 0.91 L of total volume per hour (interquartile range, 0.54-1.50 L/h) had been administered preoperatively to these patients. The postoperative 30-day mortality rate was 15.3% (38 deaths). The preoperative rate of fluid infusion correlated with 30-day mortality after adjustment for confounding factors, and the association persisted robustly through sensitivity analyses: each additional liter per hour increased the odds of perioperative death by 1.57-fold (95% confidence interval, 1.06-2.33; P = .026).

CONCLUSIONS

Aggressive volume resuscitation of patients with rAAAs before proximal aortic control predicted an increased perioperative risk of death, which was independent of systolic blood pressure. Therefore, volume resuscitation should be delayed until surgical control of bleeding is achieved.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Swiss Cardiovascular Centre, University Hospital Bern and University of Bern, Bern, Switzerland. florian.dick@insel.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23332983

Citation

Dick, Florian, et al. "Delayed Volume Resuscitation During Initial Management of Ruptured Abdominal Aortic Aneurysm." Journal of Vascular Surgery, vol. 57, no. 4, 2013, pp. 943-50.
Dick F, Erdoes G, Opfermann P, et al. Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. J Vasc Surg. 2013;57(4):943-50.
Dick, F., Erdoes, G., Opfermann, P., Eberle, B., Schmidli, J., & von Allmen, R. S. (2013). Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. Journal of Vascular Surgery, 57(4), 943-50. https://doi.org/10.1016/j.jvs.2012.09.072
Dick F, et al. Delayed Volume Resuscitation During Initial Management of Ruptured Abdominal Aortic Aneurysm. J Vasc Surg. 2013;57(4):943-50. PubMed PMID: 23332983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. AU - Dick,Florian, AU - Erdoes,Gabor, AU - Opfermann,Philipp, AU - Eberle,Balthasar, AU - Schmidli,Juerg, AU - von Allmen,Regula S, Y1 - 2013/01/18/ PY - 2012/07/24/received PY - 2012/09/25/revised PY - 2012/09/25/accepted PY - 2013/1/22/entrez PY - 2013/1/22/pubmed PY - 2013/5/23/medline SP - 943 EP - 50 JF - Journal of vascular surgery JO - J Vasc Surg VL - 57 IS - 4 N2 - OBJECTIVE: In acute traumatic bleeding, permissive arterial hypotension with delayed volume resuscitation is an established lifesaving concept as abridge to surgical control. This study investigated whether preoperatively administered volume also correlated inversely with survival after ruptured abdominal aortic aneurysm (rAAA). METHODS: This retrospective study analyzed prospectively collected and validated data of a consecutive cohort of patients with rAAAs (January 2001 to December 2010). Generally, fluid resuscitation was guided clinically by the patient's blood pressure and consciousness. All intravenous fluids (crystalloids, colloids, and blood products) administered before aortic clamping or endovascular sealing were abstracted from paramedic and anesthesia documentation and normalized to speed of administration (liters per hour). Logistic regression modeling, adjusted for suspected confounding covariates, was used to investigate whether total volume was independently associated with risk of death within 30 days of rAAA repair. RESULTS: A total of 248 patients with rAAAs were analyzed, of whom 237 (96%) underwent open repair. A median of 0.91 L of total volume per hour (interquartile range, 0.54-1.50 L/h) had been administered preoperatively to these patients. The postoperative 30-day mortality rate was 15.3% (38 deaths). The preoperative rate of fluid infusion correlated with 30-day mortality after adjustment for confounding factors, and the association persisted robustly through sensitivity analyses: each additional liter per hour increased the odds of perioperative death by 1.57-fold (95% confidence interval, 1.06-2.33; P = .026). CONCLUSIONS: Aggressive volume resuscitation of patients with rAAAs before proximal aortic control predicted an increased perioperative risk of death, which was independent of systolic blood pressure. Therefore, volume resuscitation should be delayed until surgical control of bleeding is achieved. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/23332983/Delayed_volume_resuscitation_during_initial_management_of_ruptured_abdominal_aortic_aneurysm_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(12)02118-0 DB - PRIME DP - Unbound Medicine ER -