PDF(Pubmed)
Abstract：
UNASSIGNED: This study aimed to compare the short-term outcomes of surgical treatment for acute type A aortic dissection between patients undergoing cardiopulmonary arrest at the time of entry into the operating room and patients who received successful preoperative cardiopulmonary resuscitation before entering the operating room or patients who had cardiopulmonary arrest on the operating room table after entering the operating room without cardiopulmonary arrest. In the present study, we focused on the circulatory status at the time of entering the operating room because it is economically and emotionally difficult to cease intervention once the patient has entered the operating room, where surgeons, anesthesiologists, nurses, and perfusionists are already present, all necessary materials are packed off and cardiopulmonary bypass have already been primed.
UNASSIGNED: Twenty (5.5%) of 362 patients who underwent surgical treatment for acute type A aortic dissection between January 2016 and March 2022 had preoperative cardiopulmonary arrest. To compare the early operative outcomes, the patients were divided into the spontaneous circulation group (n = 14, 70.0%) and the non-spontaneous circulation group (n = 6, 30.0%) based on the presence or absence of spontaneous circulation upon entering the operating room. The primary endpoint was postoperative 30-day mortality. The secondary endpoints included in-hospital complications and persistent neurological disorders.
UNASSIGNED: Thirty-day mortality was 65% (n = 13/20) in the entire cohort; 50% (n = 7/14) in the spontaneous circulation group and 100% (n = 6/6) in the non-spontaneous circulation group. The major cardiopulmonary arrest causes were aortic rupture and cardiac tamponade (n = 16; 80.0%), followed by coronary malperfusion (n = 4; 20.0%). Seven patients (50.0%) survived in the spontaneous circulation group, and none survived in the non-spontaneous circulation group (P = .044). Five survivors walked unaided and were discharged home; the remaining two were comatose and paraplegic.
UNASSIGNED: The outcomes were extremely poor in patients with acute type A aortic dissection who had preoperative cardiopulmonary arrest and received ongoing cardiopulmonary resuscitation at entry into the operating room. Therefore, surgical treatment might be contraindicated in such patients.
UNASSIGNED: Twenty (5.5%) of 362 patients who underwent surgical treatment for acute type A aortic dissection between January 2016 and March 2022 had preoperative cardiopulmonary arrest. To compare the early operative outcomes, the patients were divided into the spontaneous circulation group (n = 14, 70.0%) and the non-spontaneous circulation group (n = 6, 30.0%) based on the presence or absence of spontaneous circulation upon entering the operating room. The primary endpoint was postoperative 30-day mortality. The secondary endpoints included in-hospital complications and persistent neurological disorders.
UNASSIGNED: Thirty-day mortality was 65% (n = 13/20) in the entire cohort; 50% (n = 7/14) in the spontaneous circulation group and 100% (n = 6/6) in the non-spontaneous circulation group. The major cardiopulmonary arrest causes were aortic rupture and cardiac tamponade (n = 16; 80.0%), followed by coronary malperfusion (n = 4; 20.0%). Seven patients (50.0%) survived in the spontaneous circulation group, and none survived in the non-spontaneous circulation group (P = .044). Five survivors walked unaided and were discharged home; the remaining two were comatose and paraplegic.
UNASSIGNED: The outcomes were extremely poor in patients with acute type A aortic dissection who had preoperative cardiopulmonary arrest and received ongoing cardiopulmonary resuscitation at entry into the operating room. Therefore, surgical treatment might be contraindicated in such patients.
摘要：
■本研究旨在比较进入手术室时经历心肺骤停的患者与进入手术室前成功接受术前心肺复苏的患者或进入手术室后在手术室桌子上出现心肺骤停的患者之间的急性A型主动脉夹层手术治疗的短期结果。在本研究中,我们专注于进入手术室时的循环状态，因为一旦患者进入手术室，停止干预在经济上和情感上都很困难，外科医生，麻醉师,护士,灌注者已经在场，所有必要的材料都被打包，心肺转流术已经准备好。
■在2016年1月至2022年3月期间接受急性A型主动脉夹层手术治疗的362例患者中有20例（5.5％）出现术前心肺骤停。为了比较早期手术结果，根据进入手术室后是否存在自发循环，将患者分为自发循环组（n=14，70.0％）和非自发循环组（n=6，30.0％）。主要终点是术后30天死亡率。次要终点包括院内并发症和持续性神经系统疾病。
■在整个队列中，30天死亡率为65％（n=13/20）；自发循环组为50％（n=7/14），非自发循环组为100％（n=6/6）。心肺骤停的主要原因是主动脉破裂和心脏压塞（n=16；80.0％），其次是冠状动脉灌注不良（n=4；20.0%）。自主循环组存活7例(50.0%),在非自发循环组中没有存活(P=0.044)。五名幸存者在没有帮助的情况下行走并出院回家；其余两人昏迷和截瘫。
■急性A型主动脉夹层患者术前出现心肺骤停并在进入手术室时接受持续心肺复苏，结果极差。因此,此类患者可能有手术治疗禁忌。
■在2016年1月至2022年3月期间接受急性A型主动脉夹层手术治疗的362例患者中有20例（5.5％）出现术前心肺骤停。为了比较早期手术结果，根据进入手术室后是否存在自发循环，将患者分为自发循环组（n=14，70.0％）和非自发循环组（n=6，30.0％）。主要终点是术后30天死亡率。次要终点包括院内并发症和持续性神经系统疾病。
■在整个队列中，30天死亡率为65％（n=13/20）；自发循环组为50％（n=7/14），非自发循环组为100％（n=6/6）。心肺骤停的主要原因是主动脉破裂和心脏压塞（n=16；80.0％），其次是冠状动脉灌注不良（n=4；20.0%）。自主循环组存活7例(50.0%),在非自发循环组中没有存活(P=0.044)。五名幸存者在没有帮助的情况下行走并出院回家；其余两人昏迷和截瘫。
■急性A型主动脉夹层患者术前出现心肺骤停并在进入手术室时接受持续心肺复苏，结果极差。因此,此类患者可能有手术治疗禁忌。
