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'Aorta code' implementation and preliminary results of a multidisciplinary protocol for patients with acute aortic syndrome

Session Diseases of the Aorta ePosters

Speaker Carlos Ferrera Duran

Event : ESC Congress 2020

  • Topic : diseases of the aorta, peripheral vascular disease, stroke
  • Sub-topic : Aortic Dissection, Acute Intramural Hematoma
  • Session type : ePosters

Authors : C Ferrera Duran (Madrid,ES), I Vilacosta (Madrid,ES), J Perez-Villacastin (Madrid,ES), P Busca (Madrid,ES), A Carrero (Alcala de Henares,ES), A Martin Martinez (Leganés,ES), FJ Martin Sanchez (Madrid,ES), MJ Dominguez Garcia (Fuenlabrada,ES), I Martinez (Madrid,ES), J Cobiella (Madrid,ES), A Viana Tejedor (Madrid,ES), A Cortes Martinez (Madrid,ES), J Serrano (Madrid,ES), M Bas Villalobos (Madrid,ES), L Maroto-Castellanos (Madrid,ES)

Authors:
C Ferrera Duran1 , I Vilacosta1 , J Perez-Villacastin1 , P Busca2 , A Carrero3 , A Martin Martinez4 , FJ Martin Sanchez5 , MJ Dominguez Garcia6 , I Martinez1 , J Cobiella1 , A Viana Tejedor1 , A Cortes Martinez7 , J Serrano1 , M Bas Villalobos1 , L Maroto-Castellanos1 , 1Hospital Clinic San Carlos, Cardiovascular Institute - Madrid - Spain , 2Servicio de Urgencia Medica de la Comunidad de Madrid (SUMMA 112) - Madrid - Spain , 3PRINCIPE DE ASTURIAS UNIVERSITY HOSPITAL - MADRID HEALTH SERVICE, Emergency - Alcala de Henares - Spain , 4University Hospital Severo Ochoa - Leganés - Spain , 5Hospital Clinic San Carlos, Emergency - Madrid - Spain , 6University Hospital of Fuenlabrada, Emergency - Fuenlabrada - Spain , 7Hospital Clinic San Carlos, Innovation Unit-San Carlos Investigation Institute - Madrid - Spain ,

Topic(s):
Acute Aortic Syndromes, Aortic Dissection

Background
Expediting life-saving care for patients with acute aortic syndrome (AAS) through multi-disciplinary code protocols is a potential method to improve outcomes. Other code protocols for cardiovascular emergencies, such as ST-elevation myocardial infarction and stroke have shown excellent results.

Aim
To examine the implementation and preliminary results of a code protocol "Aorta Code" for patients with AAS in a healthcare framework of a 4-hospital network in our city by reviewing the number of patients detected, patient's transference time, aortic surgery and patient's outcome during a trial period of 10 months (April 2019-January 2020). A comparison with a previous 2-year period with standard of care management of AAS was performed.

Methods
"Aorta Code" uses a specific diagnostic algorithm to improve detection of patients with AAS at the emergency room, facilitates their quick transfer to the referral hospital by activating a paging system, and places acute cardiovascular care unit, operating room and surgeons specialized in aortic pathology on standby.

Results
Compared to a previous 2-year period (2017-2018) (group I), the current implementation of "Aorta Code" in a period of 10 months (group II) in our 4-hospital network involving the healthcare of 1.100000 inhabitants resulted in the detection of more patients with AAS (group-I: n=18 patients (0.8 patients/month), group-II: n=19 patients (1.9 patients/month); p=0.013). AAS detection in secondary hospitals importantly increased (33.3% vs 63.8%, p=0.07). The "Aorta Code" achieved a significant decrease in patient´s transference time to referral hospital (group-I: median 259 min (IQR 150-1911), group-II: median 129 min (IQR 95.5-167.25); p= 0.035).  There was a marked reduction in the number of surgeons involved in the "Aorta Code" (group-I= 7 cardiac, 6 vascular, group-II= 2 cardiac, 2 vascular). Thirty-day mortality was lower in group-II in the whole AAS cohort (group-I= 22.2%, group-II= 12.5%; p= 0.660) and in type A AAS (28.6% vs 18.2%, p=0.661). Misdiagnosis rate (false-calls): 11 patients (7 of them with non-acute aortic disease).

Conclusion
"Aorta Code" facilitates detecting patients with AAS at the emergency room, speeds them to the referral hospital center, allows patients to be treated by surgeons specialized in aortic surgery and improves patient's outcome. Further prospective studies examining the utility of "Aorta Code" are warranted.

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