Prehospital alert for activation of severe hemorrhage control in acute aortic emergencies : data from a regional SOS Aorta network

Position du problème et objectif(s) de l’étude

Background: Acute aortic pathologies, such as ruptured aortic aneurysms and acute aortic syndromes, are rare but carry high mortality rates, mainly due to severe hemorrhage. Timely, coordinated management in specialized centers is recommended and critical for survival, prompting the development of dedicated care pathways to optimize resuscitation and surgical readiness. This study aims to identify predictive criteria for severe hemorrhage based on data available before transfer or upon arrival at the referral center, with the goal of facilitating the early activation of massive transfusion protocols.

Matériel et méthodes

Material and Methods: Data from patients referred to a regional University Hospital in France, through the "SOS Aorta" network were prospectively collected between January 2018 and December 2023. Severe hemorrhage was defined as any of the following: packed red blood cell (RBC) transfusion before arrival at the expert center, transfusion of ≥4 RBC units (autologous or allogeneic) within the first 6 hours, or death within the first 48 hours of management. Patients were considered for analysis if they were operated within 24h. Data were analyzed using univariate analysis, followed by multivariable logistic regression to identify the most relevant predictors and develop a simple, practical clinical score. The local institutional review board approved the study (n°2019-231).

Résultats & Discussion

Results: Of the 276 patients included in the SOS Aorta registry, 124 met the inclusion criteria, of whom 62 (50%) experienced severe hemorrhage. The final prediction model was composed of 5variables: hemoglobin < 12 g/dL, systolic blood pressure < 120 mmHg, lactate > 3.5 mmol/L, age > 67 years and absence of history of peripheral arterial disease. In the score data set, having 3 criteria out of 5 yielded sensitivity of 83.5 % and specificity of 77.4 %; having 4 criteria out of 5 yielded sensitivity of 50% and specificity of 93.5%. The area under the receiver operating characteristic curve was 0.871 (95% CI : 0.808-0.933).

Conclusion

Conclusion: In patients with acute aortic emergencies requiring urgent transfer to an expert center, simple and routinely available clinical variables can help promptly identify those at risk of severe hemorrhage and guide early management decisions.

Auteurs

Charles BRAVETTI, Phillipe GUERCI - (1)Chru Nancy, Nancy, France

Orateur(s)

Charles BRAVETTI (Nancy)