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"Drum Tower Hospital" strategy for acute type A aortic dissection with coma
Ya-Peng Wang1, Li-Chong Lu2,3,4,5, Shu-Chun Li2,3,4,5
1Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China.
Perfusion
|October 27, 2023
Summary
Acute type A aortic dissection (ATAAD) with coma presents a high mortality risk. A multimodal brain assessment strategy, including quantitative electroencephalogram (qEEG), shows promise for managing these critical cases.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Acute type A aortic dissection (ATAAD) with persistent coma is a critical condition with high mortality and poor neurological outcomes.
- Optimal surgical timing and treatment strategies for ATAAD with coma remain uncertain.
- Many patients are deemed ineligible for surgery due to poor prognosis.
Purpose of the Study:
- To present a case study of a patient with ATAAD and persistent coma.
- To evaluate the feasibility and potential efficacy of the "Drum Tower Hospital" strategy in managing ATAAD with coma.
- To highlight the role of multimodal brain assessment in guiding treatment decisions.
Main Methods:
- A 53-year-old male patient with hypertension presented with a 9-hour coma and diagnosed ATAAD.
- The "Drum Tower Hospital" strategy was employed, including computed tomography angiography (CTA) and quantitative electroencephalogram (qEEG) monitoring.
- Surgical interventions included emergency stenting and aortic replacement, followed by postoperative qEEG monitoring.
Main Results:
- Preoperative and postoperative qEEG monitoring indicated improvements in brain function.
- The patient underwent successful aortic repair and stenting.
- Despite developing hemiplegia and a neurological deficit, the strategy showed potential benefits.
Conclusions:
- The "Drum Tower Hospital" strategy, incorporating multimodal brain assessment, offers a potential approach for managing ATAAD with coma.
- Quantitative electroencephalogram (qEEG) monitoring can aid in assessing brain function during treatment.
- Further research is necessary to establish definitive treatment protocols for this challenging patient population.
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