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Objective: To describe the outcomes of patients with acute aortic syndromes (AAS) who were transferred to a tertiary aortic center by a rapid transport system.
Methods: Review of patients with AAS who were transferred by a rapid transport system to a tertiary aortic center was performed. Data regarding demographics, diagnosis, comorbidities, transportation, and hospital course were acquired. Severity of existing comorbidities was determined by the Society for Vascular Surgery (SVS) comorbidity score and the APACHE II score assessed physiologic instability. Risk factors associated with in-hospital mortality of transferred patients were identified using univariate analysis and multivariate linear regression.
Results: From December 2013 to July 2015, 183 patients were transferred by an established rapid transport system. 145 patients were transported by ground (81%) and 35 by air (19%). Mean distance traveled was 39 miles (3.65-315.7 miles). Mean transport time was 46 minutes (10-144 minutes). Three patients died during transport: two with Type A dissections and one a ruptured aortic aneurysm. On arrival, three patients had no aortic pathology and 115 (63%) received operative intervention. Median time to intervention was 6 hours. Type B dissections had the longest time to intervention (median: 45.1 hrs) with an in-hospital mortality of 1.9% (1/51), while type A dissections had the shortest time to intervention (median: 3.1 hrs) and an in-hospital mortality of 15% (10/65). Patients presenting with aortic aneurysms had an in-hospital mortality of 24% (12/50). Overall, the in-hospital mortality for transferred patients was 14% (25/180). Significant factors associated with in-hospital mortality on univariate analyses were systolic BP≤90 mmHg on arrival, age > 65, history of CAD or prior cardiac surgery, complaints of chest or abdominal pain, APACHE II score ≥ 10, SVS score ≥ 8 and diagnosis of aortic aneurysm. Neither distance traveled, transport mode or time was associated with mortality. On multivariate analysis, only APACHE II ≥10 (OR: 4.37, 95% CI:1.27-15.0), age >65 (OR: 4.7, 95% CI: 1.15-19.2) and SVS score ≥8 (OR: 5.52, 95% CI: 1.9-16.1) were independently associated with increased in-hospital mortality.
Conclusion: Implementation of a rapid transport system, regardless of mode or distance, can facilitate effective transfer of patients with AAS to a regional aortic center. Older patients with high APACHE and SVS scores are more likely to die in hospital despite successful rapid transport.