Non-traumatic aortic dissection or rupture as cause of cardiac arrest: presentation and outcome.
OBJECTIVE
To evaluate the frequency, presentation and outcome of non-traumatic aortic dissection/rupture as a cause of cardiac arrest.


METHODS
Retrospective analysis of a cardiac arrest registry in a tertiary care hospital emergency department.


RESULTS
Over 11.5 years, aortic dissection/rupture was identified as the immediate cause of cardiac arrest in 46 (2,3%) out of 1990 patients with sudden cardiac arrest, primarily affecting the abdominal aorta in 25 and the thoracic aorta in 21 cases. The characteristics of the 46 patients were as follows: male gender (74%), median age 71 years (IQR 59-76), high co-morbidity (89%), previously known aortic aneurysm (33%), pulseless electric activity (70%) as initial cardiac rhythm. When performed, bedside abdominal sonography or echocardiography was almost always diagnostic. Patients with abdominal aortic dissection/rupture had abdominal (52%) and/or flank pain (32%). Patients with thoracic aortic dissection/rupture complained of chest pain (48%) or dyspnoea (19%). Return of spontaneous circulation occurred in 12 (26%) of 46 patients, emergency surgery was performed in eight of these patients, 2 (4%) survived to discharge in good neurological condition.


CONCLUSIONS
Cardiac arrest caused by aortic dissection/rupture is rare, and mortality remains very high, even when circulation can be restored initially. Common features such as previously known aortic aneurysm, old age, male gender and pulseless electrical activity as initial cardiac rhythm should increase suspicion of the condition.
Meron
Giora
G
Department of Emergency Medicine, Universitätsklinik für Notfallmedizin, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20/6D, AKH Wien, Vienna 1090, Austria.
Kürkciyan
Istepan
I
Sterz
Fritz
F
Tobler
Karin
K
Losert
Heidrun
H
Sedivy
Roland
R
Laggner
Anton N
AN
Domanovits
Hans
H
D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D001317:Austria; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome