title: A ruptured abdominal aortic aneurysm that requires preoperative cardiopulmonary resuscitation is not necessarily lethal.
abstract: OBJECTIVE
  A ruptured abdominal aortic aneurysm (RAAA) is associated with a high mortality rate. If cardiopulmonary resuscitation (CPR) is required before surgical repair, mortality rates are said to approach 100%. The aim of this multicenter, retrospective study was to study outcome in RAAA patients who required CPR before a surgical (endovascular or open) repair (CPR group). RAAA patients who did not need CPR served as controls (non-CPR group).
  
  
  METHODS
  Over a 5-year time period, demographic and clinical characteristics and specifics of preoperative CPR if necessary were studied in all patients who were treated for a RAAA in three large, nonacademic hospitals.
  
  
  RESULTS
  A total of 199 consecutive RAAA patients were available for analysis; 176 patients were surgically treated. Thirteen of these 176 patients (7.4%) needed CPR, and 163 (92.6%) did not. A 38.5% (5 of 13) survival rate was observed in the CPR group. Thirty-day mortality was almost three times greater in the CPR group compared with the non-CPR group (61.5% vs 22.7%; P = .005). Both CPR patients who received endovascular aortic repair survived. In contrast, survival in 11 CPR patients who underwent open RAAA repair was 27% (3 of 11; P = .128). A trend for higher Hardman index was found in patients who received CPR compared with patients who did not receive CPR (P = .052). The 30-day mortality in patients with a 0, 1, 2, or 3 Hardman index was 16.1%, 31.0%, 37.9%, and 33.3%, respectively (P = .093).
  
  
  CONCLUSIONS
  An RAAA that requires preoperative CPR is not necessarily a lethal combination. Patient selection must be tailored before surgery is denied.
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands.
authors.forename: Pieter P H L
authors.initials: PP
authors.lastname: Broos
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands.
authors.forename: Yannick W
authors.initials: YW
authors.lastname: 't Mannetje
authors.affiliation: Department of Vascular Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Maarten J A
authors.initials: MJ
authors.lastname: Loos
authors.affiliation: Department of Vascular Surgery, Máxima Medical Center, Veldhoven, The Netherlands; Department of Surgery, CARIM Research School, Maastricht University, Maastricht, The Netherlands.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Scheltinga
authors.affiliation: Department of Vascular Surgery, Atrium Medical Center, Heerlen, The Netherlands.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Bouwman
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Philippe W M
authors.initials: PW
authors.lastname: Cuypers
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Marc R H M
authors.initials: MR
authors.lastname: van Sambeek
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands. Electronic address: joep.teijink@cze.nl.
authors.forename: Joep A W
authors.initials: JA
authors.lastname: Teijink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018579:Patient Selection; D011300:Preoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality