One-year Outcomes After Implementation Of A Ruptured Abdominal Aortic Aneurysm Protocol

Abstract

OBJECTIVE Societal guidelines recommend protocol establishment for patients with ruptured abdominal aortic aneurysms (rAAA), but few reports exist. We describe 1-year outcomes after implementing a rAAA protocol and a survey of team member perceptions. METHODS This was a multi-hospital single healthcare network pre-post investigation (2017-2020) where a single quaternary university hospital (QUH) receives rAAA transfers. Protocol activation engages a multidisciplinary team including vascular surgery, anesthesia, operating room (OR) and emergency department (ED) staff, and was implemented in Feb 2020. Patients are routed from the helipad to the OR or ED for expedited management. Primary outcomes were time from QUH arrival to OR and 30-day mortality. Post-protocol outcomes were compared to historical controls (2017-2019). As a qualitative adjunct, we conducted a survey examining perceptions among participants at 1-year post implementation. Results: 88 patients with rAAA presented during our study period (42 pre; 46 post). Protocol activation occurred in 32 (70%) of post-protocol patients. Presenting characteristics were similar between groups (Table 1). QUH arrival time to OR was lower for the post protocol cohort compared to historical controls (pre 88.9±78.5; post 24.6±28.4 minutes; p<0.01). 30-day mortality did not differ significantly between groups (pre N=17(40%); post N=13(41%); P=.8). Most survey participants believed the protocol improved safety (65%) and care efficiency (63%). Almost all (89%) would want the protocol activated for a family member (Table 2). CONCLUSIONS rAAA protocol implementation reduced OR arrival time and improved patient safety and efficiency perspectives among staff. Protocol development should be considered at centers with high volumes of rAAA. Societal guidelines recommend protocol establishment for patients with ruptured abdominal aortic aneurysms (rAAA), but few reports exist. We describe 1-year outcomes after implementing a rAAA protocol and a survey of team member perceptions. This was a multi-hospital single healthcare network pre-post investigation (2017-2020) where a single quaternary university hospital (QUH) receives rAAA transfers. Protocol activation engages a multidisciplinary team including vascular surgery, anesthesia, operating room (OR) and emergency department (ED) staff, and was implemented in Feb 2020. Patients are routed from the helipad to the OR or ED for expedited management. Primary outcomes were time from QUH arrival to OR and 30-day mortality. Post-protocol outcomes were compared to historical controls (2017-2019). As a qualitative adjunct, we conducted a survey examining perceptions among participants at 1-year post implementation. Results: 88 patients with rAAA presented during our study period (42 pre; 46 post). Protocol activation occurred in 32 (70%) of post-protocol patients. Presenting characteristics were similar between groups (Table 1). QUH arrival time to OR was lower for the post protocol cohort compared to historical controls (pre 88.9±78.5; post 24.6±28.4 minutes; p<0.01). 30-day mortality did not differ significantly between groups (pre N=17(40%); post N=13(41%); P=.8). Most survey participants believed the protocol improved safety (65%) and care efficiency (63%). Almost all (89%) would want the protocol activated for a family member (Table 2). rAAA protocol implementation reduced OR arrival time and improved patient safety and efficiency perspectives among staff. Protocol development should be considered at centers with high volumes of rAAA.