title: Controlled hypotension in patients suspected of a ruptured abdominal aortic aneurysm: feasibility during transport by ambulance services and possible harm.
abstract: OBJECTIVE
  To evaluate a controlled hypotension protocol for patients suspected of a ruptured aneurysm of the abdominal aorta (RAAA) and to identify possible harm to patients with a final diagnosis other than RAAA.
  
  
  METHODS
  Retrospective analysis of patients suspected of RAAA and transported by Amsterdam ambulance services between January 2006 and October 2007.
  
  
  METHODS
  Protocol was assessed by reviewing systolic blood pressure (<80 mmHg, 80-100 mmHg or >100 mmHg), administered fluid volume and verbal responsiveness during transport. Patients who could possibly have been harmed by controlled hypotension were identified by final diagnoses.
  
  
  RESULTS
  Fluid administration was according to protocol in 220 of 266 patients analysed for protocol adherence. The remaining patients received too much (21 patients) or too little fluid (25 patients). Data were missing in 29 patients. A RAAA was diagnosed in 81 (27%) of all 295 patients analysed for final diagnosis. Controlled hypotension was achieved in 10% of all patients and in 17% of patients with RAAA. Three patients (1%) with diagnosis other than RAAA were possibly at risk by implementing controlled hypotension.
  
  
  CONCLUSIONS
  Protocol was followed in 83% and protocol violations occurred in 17% of patients. The risk of implementing controlled hypotension for all patients suspected of an RAAA by the ambulance staff was low.
authors.affiliation: Department of Vascular Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Reimerink
authors.forename: L L
authors.initials: LL
authors.lastname: Hoornweg
authors.forename: A C
authors.initials: AC
authors.lastname: Vahl
authors.forename: W
authors.initials: W
authors.lastname: Wisselink
authors.forename: R
authors.initials: R
authors.lastname: Balm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001019:Aortic Rupture / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure; D002985:Clinical Protocols; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D019983:Guideline Adherence; D006801:Humans; D007023:Hypotension, Controlled / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome