1. Peri-operative Hypotension in Patients with Ruptured Abdominal Aortic Aneurysms
Rooney H1, Lewis M2, Urriza- Rodriguez D3, Mouton R1
1. Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust
2. School of Clinical Sciences, University of Bristol, Bristol , UK
3. Department of Surgery, Southmead Hospital, North Bristol NHS Trust
Jonathan,
The lower border of the Gloucestershire Hospitals NHS Foundation Trust text should align with the affiliations text
Purpose duplicates words unnecessarily – see edits, spacing of text 1.5 lines rather than 1
Ditto Methods – more concise
Results – centre align the AMD-total columns vertically and horizontally – a bit more like the above but scale to fit etc
Number of injections scale has far too many increments eg just have 0, 2,500, 5000, and the word ‘Given’ is unnecessary in the Y axis title
The conclusions for nurses do not need to duplicate the statement on significance of grade
Please use the Medisoft logo off Miranda’s poster which is the correct shaper
Introduction
Mortality linked to ruptured abdominal aortic aneurysms remains high
37% open repair
25% endovascular repair
Traditionally, permissive hypotension with limited pre-operative fluid resuscitation is advocated in managing ruptured AAA 1, 2
IMPROVE suggested a correlation between low systolic blood pressure (SBP) & increased mortality 3
ASA Grade
ASA Grade Frequency Percent
1 0 1
2 4 5
Total
Results
Table 1. Sample details including gender distribution and ASA class 1.
Figure 1. Percentage of pre-operative SBP ranges across study
Aims
To establish the current spectrum of SBP at presentation in our vascular centre
To explore the correlation between both peri- and intraoperative SBP and 30-day mortality rate
Methods
Retrospective observational study
Included all patients presenting to Bristol, Bath & Weston hospitals from Oct Oct 2016 (n=73 total)
Patients identified from National Vascular Registry; and case notes, imaging & investigations examined
Primary outcome 30-day mortality
Data were analysed using SPSS (IBM, United States)
Χ2 tests were performed to estimate significance of relationship between perioperative SBP and mortality risk
Figure 2. Pre-operative and intra-operative systolic blood pressure (SBP) categorised and compared against death at 30 days post-operatively. Data normalised to category size. * denotes significance at p< The only significant pre-operative observation was that a SBP >120 seems to be protective; intra-operatively, a SBP >100 is protective whilst an SBP <70 mmHg at the nadir is strongly associated with death.
Preoperatively
A lowest SBP >120 mmHg is strongly correlated with survival at 30 days
If the lowest measured SBP was between 70 – 98 mmHg, there was a trend to excess mortality that did not reach significance
Surprisingly a very low SBP (<70 mmHg) was not associated with death in our sample.
Intraoperatively
-A lowest SBP <70 mmHg was strongly associated with death, whereas a lowest BP >99 mmHg correlated with survival
Data on fluid resuscitation was poorly recorded in the original notes, and so we were unable to determine a relationship between resuscitation of the shocked patient and survival.
Conclusions
We have observed a positive survival benefit in patients who registered a preoperative SBP >120 mmHg. Preoperatively, a moderately low SBP was associated with increased 30-day mortality, although a very low SBP <70 mmHg intraoperatively.was the factor most strongly associated with post-operative death
These results suggest a more complex relationship between presenting physiology and eventual outcome than a simple correlation between SBP and mortality
Further work is needed to dissect the influence of presenting physiological parameters upon mortality; and ultimately establish an ideal resuscitation regimen
A prospective study would be ideal to obtain comprehensive information and include multiple variables for resuscitation in the analysis
References
Revell M, et al. Endpoints for fluid resuscitation in hemorrhagic shock. J Trauma 2003, 54(5, suppl):S63-S67
Dick F, et al. Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. J Vasc Surg 2013, 57(4):943-50
IMPROVE Trial Investigators, Powell JT, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 2014; 348 :f7661