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• W4292397188 abstract "BackgroundDespite recommendations for permissive hypotension during transfer of patients with ruptured abdominal aortic aneurysm (rAAA), no consensus exists about optimal blood pressure (BP) management. We aimed to evaluate the effects of hypertension and severe hypotension during inter-hospital transfers in a cohort of hypotensive patients with rAAA.MethodsWe performed a retrospective, single institution review of rAAA patients transferred via air ambulance to a quaternary referral center for repair (2003-2019). Vitals were recorded every 5 minutes in transit. Hypotension was defined as systolic BP of less than 90 mm Hg and hypertension as greater than 140 mm Hg. The primary cohort included those with any hypotension during transfer. The primary analysis compared those who experienced any hypertensive episode to those who did not. A secondary analysis evaluated those with severe hypotension of less than 70 mm Hg. The primary outcome was 30-day mortality.ResultsDetailed BP data were available for 271 patients; 125 (46.1%) had at least one episode of hypotension. The mean age was 74.2 ± 9.1 years, 93 (74.4%) were male, and the median total transport time was 65 minutes (interquartile range [IQR], 46-79 minutes). Within this hypotensive cohort, 26.4% (n = 33) had at least one episode of hypertension. There were no significant differences in age, gender, comorbidities, AAA repair type (open 75% vs endovascular 25%), or AAA anatomic location between hypertensive and nonhypertensive groups. There was no difference in fluid resuscitation volume (0.7 L [IQR, 0.4-1.2]), blood transfusion volume (0.3 L [IQR, 0-0.5]), or vasopressor administration between groups during transfer. Hypertension was associated with significantly increased 30-day mortality on multivariable logistic regression (adjusted odds ratio [aOR], 4.5; 95% confidence interval [CI], 1.34-14.75]; 59.4% [n = 19] vs 40.2% [n = 37]; P = .01) (Table). Severe hypotension (46%; n = 57) was also associated with higher 30-day mortality (aOR, 2.8; 95% CI, 1.3-6.3; 60% [n = 34] vs 32% [n = 22]; P = .01). Those with either hypertension or severe hypotension (54%; n = 67) also had increased odds of mortality (aOR, 3.2; 95% CI, 1.4-7.2; 58% [ n = 38] vs 31% [n = 18]; P < .01). Time spent in each BP category was not significantly associated with mortality.ConclusionsTableMultivariable logistic regression model for 30-day mortality in patients with hypotensionVariableaOR95% CIP valueHypertensive episode (>140 mm Hg)4.451.34-14.75.01Endovascular repair0.370.09-1.48.16Age, years1.081.01-1.15.02Female1.300.39-4.36.68Transit crystalloid, mL1.310.55-3.13.55Transit packed red blood cells, units1.370.73-2.55.32Transit time, minutes1.010.96-1.05.81aOR, Adjusted odds ratio; CI, confidence interval. Open table in a new tab BackgroundDespite recommendations for permissive hypotension during transfer of patients with ruptured abdominal aortic aneurysm (rAAA), no consensus exists about optimal blood pressure (BP) management. We aimed to evaluate the effects of hypertension and severe hypotension during inter-hospital transfers in a cohort of hypotensive patients with rAAA. Despite recommendations for permissive hypotension during transfer of patients with ruptured abdominal aortic aneurysm (rAAA), no consensus exists about optimal blood pressure (BP) management. We aimed to evaluate the effects of hypertension and severe hypotension during inter-hospital transfers in a cohort of hypotensive patients with rAAA. MethodsWe performed a retrospective, single institution review of rAAA patients transferred via air ambulance to a quaternary referral center for repair (2003-2019). Vitals were recorded every 5 minutes in transit. Hypotension was defined as systolic BP of less than 90 mm Hg and hypertension as greater than 140 mm Hg. The primary cohort included those with any hypotension during transfer. The primary analysis compared those who experienced any hypertensive episode to those who did not. A secondary analysis evaluated those with severe hypotension of less than 70 mm Hg. The primary outcome was 30-day mortality. We performed a retrospective, single institution review of rAAA patients transferred via air ambulance to a quaternary referral center for repair (2003-2019). Vitals were recorded every 5 minutes in transit. Hypotension was defined as systolic BP of less than 90 mm Hg and hypertension as greater than 140 mm Hg. The primary cohort included those with any hypotension during transfer. The primary analysis compared those who experienced any hypertensive episode to those who did not. A secondary analysis evaluated those with severe hypotension of less than 70 mm Hg. The primary outcome was 30-day mortality. ResultsDetailed BP data were available for 271 patients; 125 (46.1%) had at least one episode of hypotension. The mean age was 74.2 ± 9.1 years, 93 (74.4%) were male, and the median total transport time was 65 minutes (interquartile range [IQR], 46-79 minutes). Within this hypotensive cohort, 26.4% (n = 33) had at least one episode of hypertension. There were no significant differences in age, gender, comorbidities, AAA repair type (open 75% vs endovascular 25%), or AAA anatomic location between hypertensive and nonhypertensive groups. There was no difference in fluid resuscitation volume (0.7 L [IQR, 0.4-1.2]), blood transfusion volume (0.3 L [IQR, 0-0.5]), or vasopressor administration between groups during transfer. Hypertension was associated with significantly increased 30-day mortality on multivariable logistic regression (adjusted odds ratio [aOR], 4.5; 95% confidence interval [CI], 1.34-14.75]; 59.4% [n = 19] vs 40.2% [n = 37]; P = .01) (Table). Severe hypotension (46%; n = 57) was also associated with higher 30-day mortality (aOR, 2.8; 95% CI, 1.3-6.3; 60% [n = 34] vs 32% [n = 22]; P = .01). Those with either hypertension or severe hypotension (54%; n = 67) also had increased odds of mortality (aOR, 3.2; 95% CI, 1.4-7.2; 58% [ n = 38] vs 31% [n = 18]; P < .01). Time spent in each BP category was not significantly associated with mortality. Detailed BP data were available for 271 patients; 125 (46.1%) had at least one episode of hypotension. The mean age was 74.2 ± 9.1 years, 93 (74.4%) were male, and the median total transport time was 65 minutes (interquartile range [IQR], 46-79 minutes). Within this hypotensive cohort, 26.4% (n = 33) had at least one episode of hypertension. There were no significant differences in age, gender, comorbidities, AAA repair type (open 75% vs endovascular 25%), or AAA anatomic location between hypertensive and nonhypertensive groups. There was no difference in fluid resuscitation volume (0.7 L [IQR, 0.4-1.2]), blood transfusion volume (0.3 L [IQR, 0-0.5]), or vasopressor administration between groups during transfer. Hypertension was associated with significantly increased 30-day mortality on multivariable logistic regression (adjusted odds ratio [aOR], 4.5; 95% confidence interval [CI], 1.34-14.75]; 59.4% [n = 19] vs 40.2% [n = 37]; P = .01) (Table). Severe hypotension (46%; n = 57) was also associated with higher 30-day mortality (aOR, 2.8; 95% CI, 1.3-6.3; 60% [n = 34] vs 32% [n = 22]; P = .01). Those with either hypertension or severe hypotension (54%; n = 67) also had increased odds of mortality (aOR, 3.2; 95% CI, 1.4-7.2; 58% [ n = 38] vs 31% [n = 18]; P < .01). Time spent in each BP category was not significantly associated with mortality. ConclusionsTableMultivariable logistic regression model for 30-day mortality in patients with hypotensionVariableaOR95% CIP valueHypertensive episode (>140 mm Hg)4.451.34-14.75.01Endovascular repair0.370.09-1.48.16Age, years1.081.01-1.15.02Female1.300.39-4.36.68Transit crystalloid, mL1.310.55-3.13.55Transit packed red blood cells, units1.370.73-2.55.32Transit time, minutes1.010.96-1.05.81aOR, Adjusted odds ratio; CI, confidence interval. Open table in a new tab aOR, Adjusted odds ratio; CI, confidence interval." @default.
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• W4292397188 date "2022-09-01" @default.
• W4292397188 modified "2023-09-25" @default.
• W4292397188 title "Blood Pressure Control During Transfer for Patients With Ruptured Abdominal Aortic Aneurysms" @default.
• W4292397188 doi "https://doi.org/10.1016/j.jvs.2022.06.065" @default.
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