Hospital wins battle against time for one patient’s aortic emergency

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TAAA rupture, though uncommon, is recognized as one of the most complex aortic emergencies to treat

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Aortic emergencies, if not diagnosed and managed in due time, are, of course, life threatening. Responding to them effectively requires the rapid activation of a complex health ecosystem. Even when these responses are done well, the healthcare team must still battle against unfavorable mortality odds.

Such was the case in Florida, when a patient was found down in his home, pale and diaphoretic. The EMS team, unable to obtain a blood pressure, initiated resuscitation efforts and transferred him to a community hospital in the area. There, a computed tomography (CT) angiogram of the chest, abdomen and pelvis with contrast confirmed that the patient was suffering a ruptured fusiform thoracoabdominal aortic aneurysm (TAAA), a diagnosis the hospital recognized needed specialty care they were not equipped to offer.

A TAAA occurs when the abdominal aorta bulges from the chest into the abdomen. Left undetected and untreated, TAAA can expand beyond its normal limits and will rupture, causing uncontrolled bleeding. TAAA rupture, though uncommon, is recognized as one of the most complex aortic emergencies to treat. Each hour of delayed care increases the already staggering 80% mortality rate by an additional 1–2%, and usually results in death. So emergent are these cases that some health care organizations, like Tampa General Hospital, have crafted comprehensive policies to coordinate care and guide care teams for rapid, effective responses.

Murray Shames

In short, the patient needed the support of a Level 1 trauma center and the aortic specialization they offer. So, the care team contacted the Tampa General Hospital (TGH) Transfer Center, their aortic team, and a vascular surgeon, who requested the patient’s CT scan be transferred immediately. The vascular surgery aortic team reviewed the study to determine that they could in fact treat this emergent case.

With imaging in-hand in real time, not only was the aortic team able to confirm that they could accept the patient, they began their operative planning right away. While the patient was en route to Tampa General Hospital, his new care team got busy in a hurry—evaluating the possible repair options and preparing the cardiovascular operating room. In addition, the aortic surgical team studied the patient’s medical images to determine if endovascular surgery was an option to repair his aneurysm. When the patient arrived at Tampa General Hospital via medevac, his surgical team was ready for him.

The Society for Vascular Surgery (SVS) ruptured abdominal aortic aneurysm (rAAA) algorithm recommends that a patient be emergently evaluated and have intervention started within 30 minutes of arrival at the specialty surgical center.

The patient’s door-to-cardiovascular operating room time was 10 minutes. The patient’s operation lasted approximately five and a half hours, and he spent 28 days in the ICU recovering from this surgical emergency. To survive an aortic emergency such as this one, every second counts. More, it requires a multidisciplinary, integrated team approach ranging from imaging, radiology and superior technologies to the physicians, surgeons and nurses who care for the patient. All of these disciplines came together around a well-executed plan at Tampa General Hospital, which saved this patient’s life, and saves the lives of other TGH patients every day.

“I am incredibly proud of our aorta team. Managing complex aortic pathologies is why we are here. We are committed to providing comprehensive, multidisciplinary care using the most advanced technology available,” said Murray Shames, MD, associate director of the TGH Heart and Vascular Institute and director of the Aorta Center, professor and chief of vascular surgery at the University of South Florida (USF) Health Morsani College of Medicine, and the 2020–21 Association of Program Directors in Vascular Surgery (APDVS) president.

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