Air medical transport of suspected aortic emergencies

To review and characterize 4 years of experience with suggested nontraumatic aortic emergencies (dissections/ruptures) transported by a new, provincially dedicated rotor-wing air medical program

Retrospective 4-year review of air medical program's mission records and review of related hospital records. Patients listed as suspected aortic emergencies (nontraumatic) in the air medical records were included. Mission records were reviewed for EMS diagnosis, blood pressures before and after transport, transport times, and mortality. Hospital records were reviewed for diagnosis, interventions/treatment, and mortality. Blood pressures below 80 mmHg systolic were considered hemodynamically unstable.

A cohort of 34 patients were identified, of whom 31 (91%) arrived at the hospital alive. Twenty-five patients (74%) arrived hemodynamically stable, with a mean out-of-hospital time of 60 minutes, and nine patients (26%) were hemodynamically unstable (mean out-of-hospital time was 54 minutes). No significant difference arose in times between these two groups (P = 0.16). Overall mortality was 53% (18). Differences in transport time between survivors and deaths was not statistically significant (P = 0.93). The diagnoses on admission to hospital: 14 (41%) were RAAA, five (15%) AAA no rupture, eight (24%) aortic dissections, and four (12%) had no aortic pathology. Seventeen patients (50%) received emergent surgical intervention. The EMS diagnosis was correct in 76% of cases.

Our program transported 34 suspected aortic emergencies of which 17 were immediate surgical candidates on arrival. Aortic emergencies are not infrequent within our program. Specific policies and procedures based on continuing quality review should be in place to optimize the transport and care of these patients.