Abstract
Despite improvement in surgical technology and postoperative critical care, mortality from ruptured abdominal aortic aneurysms (AAA) remains high. We evaluated 9 consecutive patients with ruptured AAA who had cardiopulmonary arrest on arrival (CPAOA) at our medical center. The 7 men and 2 women had a mean age of 73 years with a range of 66 to 83 years. Seven patients were transported from hospitals and the others were transferred directly from the sites of the collapse. Initial diagnoses in the previous hospital were abdominal pain of unknown origin in 4, ureterolithiasis in 2 and ruptured AAA in only one, although there was a previous diagnosis of AAA in 3 patients (33%). The other 9 patients all developed cardiopulmonary arrest in the ambulance and received cardiopulmonary resuscitation (CPR). Electrocardiograms in our emergency room showed electromechanical dissociation in 6 patients and standstill in 3. Return to spontaneous circulation was obtained by CPR in the emergency room in 6 patients, and 5 of these 6 underwent emergency surgery. Cardiac arrest developed during surgery in 2 of the 5, and aneurysms were resected and replaced with a Dacron graft in the remaining 3. One patient recovered fully and returned to his usual life. One case who recovered consciousness postoperatively died of multiorgan dysfunction on the 3rd postoperative day. The remaining patient was diagnosed as having brain death postoperatively. In conclusion, to reduce the mortality from ruptured AAA, correct initial diagnosis and expeditious preoperative management are most important.
