Abstract: Poster Presentations |

Management of Suspected Aortic Dissection During Interfacility Transport: Opportunity for Beneficial Intervention by the Critical Care Transport Crew FREE TO VIEW

Stephen H. Thomas, MD MPH; Greg Winsor, RN; Paul Biddinger, MD; Suzanne K. Wedel, MD, FCCP
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Transport Service, Boston MedFlight, Boston, MA


Chest. 2003;124(4_MeetingAbstracts):181S-b-182S. doi:10.1378/chest.124.4_MeetingAbstracts.181S-b
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PURPOSE:  Blood pressure control with antihypertensive therapy (AT) is a vital component of early critical care of patients with suspected acute aortic dissection (SAD). This study’s objective was to assess the frequency and efficacy with which a critical care transport team (CCTT) instituted AT to patients undergoing interfacility (IF) transfer for a referring hospital (RH) diagnosis of SAD.

METHODS:  The study was a retrospective review of 5 years of transfers by a two-helicopter, nurse/paramedic staffed CCTT operating under protocol-guided care. Eligible patients were subjects undergoing IF transfer for SAD who did not have hypotension (systolic blood pressure [SBP]120, the RH had provided AT in 23 (54.8%).In the 19 cases where pre-transport SBP>120 but no RH AT was administered, median pre-transport SBP was 158 (range 122 to 212, interquartile range [IQR] 141-180).In 20 patients (32.3% of 62) the CCTT instituted new AT. In multivariate modeling, CCTT AT institution was associated with higher pre-transport SBP, longer CCT time, and ultimate confirmation of dissection diagnosis (probably as a surrogate marker for patient severity and/or likelihood of SAD diagnosis as perceived by the CCTT).Overall, for the 62 study patients the median SBP change from pre- to post-transport was −13.5 (IQR, −31 to +5). Post-transport average SBP (129 ± 27, 95% confidence interval [CI] for mean, 122-136) was significantly (p = .0007) lower than the average pre-transport SBP (142 ± 35.5, 95% CI 133–151).For the 42 patients with pre-transport SBP>120, the difference in pre-transport (161 ± 25, 95% CI 154 -169) and post-transport (138 ± 24, 95% CI 130 to 145) SBPs particularly marked (mean SBP decrement during transport, 24 {95% CI 16-32}; p < .0001).

CONCLUSION:  Despite advanced RH imaging and sufficiently high SAD suspicion to trigger helicopter transport, CCTT institution of AT in SAD patients is frequently indicated and appears to be efficacious. This represents an area of potentially important intervention for critical care transport services.

DISCLOSURE:  S.H. Thomas, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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