title: Repair of ruptured abdominal aortic aneurysm after cardiac arrest.
abstract: OBJECTIVE
  Cardiac arrest in patients with ruptured abdominal aortic aneurysm (rAAA) is not uncommon and associated with significantly increased mortality. Although it has been suggested as a contraindication to aortic repair, the prognostic implications of preoperative cardiac arrest in the face of rAAA are controversial. The purpose of this structured review is to analyze the reported outcomes of patients with rAAA and preoperative cardiac arrest.
  
  
  METHODS
  English language single- and multi-institutional series reporting outcomes of patients with rAAA and cardiac arrest were identified by systematic literature search and review. An aggregate analysis and structured review of outcomes after subsequent aortic repair was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The primary outcome was short-term overall mortality.
  
  
  RESULTS
  Sixteen studies involving 2669 patients with rAAA were analyzed, including 334 (13%) with preoperative cardiac arrest. Cardiac arrest was associated with significantly increased mortality compared with patients with rAAA without arrest (86% vs 44%; P < .0001), although cardiac arrest in isolation was poorly predictive of mortality. Four patients were treated by endovascular aortic repair, and all survived. Shorter resuscitation times and return of signs of life prior to aortic repair are associated with improved survival, and long-term functional outcomes among survivors have been reported.
  
  
  CONCLUSIONS
  Mortality among patients with rAAA and preoperative cardiac arrest is high but not prohibitive. Aortic repair should not be withheld from such patients who are otherwise reasonable candidates for intervention, provided resources for emergent aortic repair are available.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md. Electronic address: dharris@smail.umaryland.edu.
authors.forename: Donald G
authors.initials: DG
authors.lastname: Harris
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Danon
authors.initials: D
authors.lastname: Garrido
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Connor P
authors.initials: CP
authors.lastname: Oates
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Richa
authors.initials: R
authors.lastname: Kalsi
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Huffner
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md.
authors.forename: Shahab
authors.initials: S
authors.lastname: Toursavadkohi
authors.affiliation: Division of Vascular Surgery, Albany Medical Center, Albany, NY.
authors.forename: R Clement
authors.initials: RC
authors.lastname: Darling
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Center for Aortic Disease, University of Maryland Medical Center, Baltimore, Md.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Crawford
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D018579:Patient Selection; D012307:Risk Factors; D016896:Treatment Outcome