A 24/7program fora orticem ergencies in«iledefrance»
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1 SOS A ORTA A 24/7program fora orticem ergencies in«iledefrance» P aulacho U H,M D,P hd DirectorofT horacicaortics urgery P rogram EuropeanHospitalGeorgesP om pidou & P aris-descartesu niversity,p aris,france
2 Suspected orcon firm ed aortic em ergen cies Acute aortic syndroms Complicated or symptomatic aortic aneurysms Traumatic aortic rupture
3 type A dissection/y in IDF Mortality 1% / h 200 ruptured AAA /y Mortality = 48 % * Km 2 Pop. 12 millions * Meta-analysis of 171 studies since Brown et al. Br J surg severe polytrauma patients/ y
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6 Before SOS Aorta Cases are scattered around different hospitals Lower case-volume per hospital. longer learning curve Multidisciplinary approach is not available in most of these hospitals
7 Before SOS Aorta No defined contact nor phone number No dedicated unit No decisionnal algorythms No standardized diagnosis workup or treatment Loss of time loss of means loss of lives?
8 SOS Aorta : One phone number, dedicated to aortic emergencies, 24/7 (senior physician) SSPI (Trauma Unit) : One dedicated admission Centre, specialized in dealing with vital emergencies & unstable patients On-call senior aortic/cv surgeon, with a dedicated phone number CV-ICU : Dedicated cardiovascular ICU On-site lifeflights Multidisciplinary approach cardiovascular surgeon, endovascular surgeon, cardiologists, on-site anesthesist, cardiovascular radiologists )
9 SOS AORTA call Pt accepted immediatly & unconditionnally, (unless ethical issues or surgical team unavailable Surgeon ( 5609) Admission flow initiated CV-OR Emergency CT scan Pré-admission Radio follow-up Arrival of pt Immediate assesment Vital emergency «minutes» Vital emergency «hours» Reorientation Other diagnosis CV-OR Imaging Work-up Diagnosis
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11 Treatment protocoles
12 SOS Aorte Prospective registry since Feb 2010
13 SOS Aorte Information campaign to ER mobile units (SAMU) & ER departments Internet for general public & professionnals French television documentary «Post-university teaching» sessions Oral presentations
14 SO S A ort e Nb pts
15 Impact of SOS Aorta on referral & mortality 461 patients referred for aortic emergencies over a 6 yearperiod SOS aorte yrs 174 patients yrs 287 patients 2011
16 Impact of SOS Aorta on referral & mortality Number pts Before SOS Aorta After SOS Aorta 58±6,6 96±17 p<0,05 Type A Dissection 28±3 42±3,6 p<0,05 Type B Dissection 18±3,2 23±5,2 p=0,1 Ruptured aneurysm 10±1,5 21±6,1 p<0,05 6±1 9±3,1 p=0,07 Before SOS Aorta After SOS Aorta 36,4±1,84% 21,6% p<0,01 Type A Dissection 53% 30% p<0,01 Type B Dissection 12% 9% p=0,1 Ruptured aneurysm 50% 23% p<0,05 Traumatic rupture of the aorta 22% 9% p<0,05 All aortic emergencies Traumatic rupture of the aorta Mortality All aortic emergencies
17 Impact of SOS Aorta on referral & mortality Before SOS Aorta After SOS Aorta Mean age 64 y (33-88) 68 y (20-93) Hemodynamic instability 12% 31% Neurologic presentation 3,1% 6% Deep hypothermic circulatory arrest 45% 62%
18 Impact of SOS Aorta on referral & mortality Geographic distribution of referred cases Outside IDF0 Outside IDF 0 12% Paris 11% Paris 28% IDF (outside Paris) 50% IDF (outside Paris) 37% 61% BeforeS O S aorta A fters O S aorta
19 SO S A ort e SOS Aorta Registry : 2/2/ /08/2016: 900 pt s Mean age 66 ans (16-100) 68% Unstable 22 % Cardiac arrest 5% (1,8% non recuperated) SAPS2 mean 38,3 ± 25,2 (New Simplified acute physiology score)
20 SO S A ort e Fin ald iagn osis Other CV 21% Aortic 67% Non CV 12%
21 SO S A ort e Fin ald iagn osis Type B dissection 18% Type A dissection 38% AAA 27% PAU 1% IMH B 2% IMH A 2% Asc/Arch TAR 1% 3% DT/TAAA 8%
22 SO S A ort e Geographic distribution Primary referral (ER Mobile U) Outside IDF 2% Ile de France (Outside Paris) 47% Paris 51%
23 SO S A ort e Pain Thoracic 44% Abdominal 30% No pain 11% Other 6% Thoracoabdominal 9%
24 SO S A ort e Neurological deficit No ND 80,3% Other 4,9% Coma 6,6% Hemiplegia Paraplegia Monoplegia 2,8% 1,8% 3,5%
25 SO S A ort e Hemodynamics Stable 53% HTN 25% Unstable 22%
26 SO S A ort e Results % ,
27 SO S A O RTA S urgicaltreatm ent Urgent surgery (before next day) 41% Surgery during hospitalisation 12% Delayed surgery 4% No surgery 41% Emergent (under CPR) 2% Median time to urgent surgery = 54 min
28 A com pl et e & m ul t id iscipl in ary m an agem en t Acute management Emergency services CV surgery CV Rehabilitation Endovascular team CV-ICU Follow-up Aortic emergency Cardiovascular radiology Blood pressure management Genetic counseling Vascular Medecine Interventionnal cardiology INSERM RESEARCH UMR 970-PARCC
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