Abstract 315: Three-Year Survey in Ishikawa Prefecture of Nontraumatic Aneurysm and Dissection of the Aorta Not Followed by Out-of-Hospital Cardiac Arrest in Patients Who Were Transported by Emergency Medical Technicians

Abstract

Aim: To investigate the signs, symptoms and incidences of aortic aneurysm/dissection (A/D) that did and did not cause OHCA and were transported by EMTs. Materials and Methods: Fire departments prospectively collected the data for cases with non-traumatic aortic A/D that were transported by EMS during the period of 2011 to 2013. The data included the backgrounds, signs and symptoms of the patients at the scene, backgrounds of the bystanders and 1-month survival. Results: As shown in Fig. 1, of 219 cases transported by Emergency Medical Technicians (EMTs) on their suspicion of aortic A/D, 140 cases were diagnosed with aortic A/D. Of 72,185 cases with endogenous medical emergency, 176 cases transported without EMT’s suspicion of aortic A/D were finally diagnosed with aortic aneurysm/dissection. In total, 316 cases had the aortic A/D. Thus, sensitivity of our regional EMS for non-traumatic aortic AD was 44% (140/316) while positive predictive value was 64% (140/219). The backgrounds of patients are as follows: male gender (51%), median value (25-75%) of age [73 (62-83)], high co-morbidity (88%). The major signs and symptoms obtained by EMTs were characterized by acute onset but mostly non-specific: chest pain (45%), back pain (40%), abdominal pain (14%). Moving severe pain was rarely caught (6%). These symptoms happened without a hard exercise (99%), and detected mainly by family members (41%) and patients themselves (34%). Bilateral blood pressure difference was rarely detected (5%). One-month survival rate was higher in cases transported to major emergency medical hospitals offering a major vascular surgery than those to other hospitals. None of other factors were associated with the survival. Conclusions: The Incidence of aortic A/D in all medical emergencies was extremely low. The survival rate may depend on the level of transported hospital. Clear criteria for “aortic transportation bypass” is required in EMS system.