Multi-institutional and multi-disciplinary care: A successfully managed aortic dissection in the third trimester of pregnancy

Multi-disciplinary collaborative care for pregnant women with complex and emergent conditions is essential. Logistical planning, clear communication and human factor awareness are all non-clinical skills which need to be utilised in order to maximise outcomes. We describe the case of a proximal aortic dissection in the late third trimester of pregnancy diagnosed in a peripheral hospital that was transferred to a cardiothoracic centre for successful operative management 160 km away. This required the time-sensitive mobilisation and liaison of a receiving cardiothoracic, anaesthesiology and perfusionist team in conjunction with obstetric and midwifery support from an affiliated maternity hospital, as well as the national neonatal transport team. We emphasise the importance of multidisciplinary team management in complex cases and how imperative good inter-disciplinary communication is to ensure safe inter-hospital transfer.

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Smartphone monitoring of in-ambulance vibration and noise

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411920985994 ◽

2021 ◽

pp. 095441192098599

Author(s):

Tom Partridge ◽

Lorelei Gherman ◽

David Morris ◽

Roger Light ◽

Andrew Leslie ◽

...

Keyword(s):

Transport Systems ◽

Vertical Acceleration ◽

Vehicle Speed ◽

Noise Levels ◽

The Road ◽

Neonatal Transport ◽

Mass Data ◽

Transport Team ◽

Vertical Accelerations ◽

Noise Vibration

Transferring sick premature infants between hospitals increases the risk of severe brain injury, potentially linked to the excessive exposure to noise, vibration and driving-related accelerations. One method of reducing these levels may be to travel along smoother and quieter roads at an optimal speed, however this requires mass data on the effect of roads on the environment within ambulances. An app for the Android operating system has been developed for the purpose of recording vibration, noise levels, location and speed data during ambulance journeys. Smartphone accelerometers were calibrated using sinusoidal excitation and the microphones using calibrated pink noise. Four smartphones were provided to the local neonatal transport team and mounted on their neonatal transport systems to collect data. Repeatability of app recordings was assessed by comparing 37 journeys, made during the study period, along an 8.5 km single carriageway. The smartphones were found to have an accelerometer accurate to 5% up to 55 Hz and microphone accurate to 0.8 dB up to 80 dB. Use of the app was readily adopted by the neonatal transport team, recording more than 97,000 km of journeys in 1 year. To enable comparison between journeys, the 8.5 km route was split into 10 m segments. Interquartile ranges for vehicle speed, vertical acceleration and maximum noise level were consistent across all segments (within 0.99 m . s−1, 0.13 m · s−2 and 1.4 dB, respectively). Vertical accelerations registered were representative of the road surface. Noise levels correlated with vehicle speed. Android smartphones are a viable method of accurate mass data collection for this application. We now propose to utilise this approach to reduce potential harmful exposure, from vibration and noise, by routing ambulances along the most comfortable roads.

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Spontaneous aortic rupture during pregnancy

Orvosi Hetilap ◽

10.1556/oh.2011.29132 ◽

2011 ◽

Vol 152 (23) ◽

pp. 929-933 ◽

Cited By ~ 1

Author(s):

Zita Pánczél ◽

Levente Sára ◽

Péter Tóth ◽

Márta Hubay ◽

Éva Keller ◽

...

Keyword(s):

Sudden Death ◽

Aortic Dissection ◽

Genetic Basis ◽

Aortic Rupture ◽

Relevant Literature ◽

Ascending Aorta ◽

Multiparous Woman ◽

Rare Entity ◽

Third Trimester ◽

The Third

Aortic dissection is a rare entity. Half of the aortic dissection cases occur during pregnancy in women under the age of 40. The authors report a case of a multiparous woman at the third trimester of her sixth pregnancy, who died from a sudden and intractable cardiovascular shock. Autopsy revealed the dissection of the ascending aorta. The case is interesting, especially because in the pregnant woman’s family it was not the first sudden death during pregnancy. Authors review the relevant literature regarding the symptoms and the genetic basis of this rare but potentially lethal complication of pregnancy. Orv. Hetil., 2011, 152, 929–933.

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G211(P) Transferring them out whilst they are still in: the experience of the emergency bed service working with the neonatal transport team

10.1136/archdischild-2018-rcpch.206 ◽

2018 ◽

Author(s):

A Onibere ◽

S Broster ◽

S O’Hare ◽

D Wari-Pepple ◽

A Dhar

Keyword(s):

Neonatal Transport ◽

Transport Team

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Control of Oxygenation during the Transport of Sick Neonates

PEDIATRICS ◽

10.1542/peds.66.1.117 ◽

1980 ◽

Vol 66 (1) ◽

pp. 117-119

Author(s):

Carol Miller ◽

Ronald I. Clyman ◽

Robert S. Roth ◽

Susan H. Sniderman ◽

Roberta A. Ballard ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Transport System ◽

Perinatal Care ◽

Acid Base ◽

Neonatal Transport ◽

Transport Team ◽

Acid Base Status ◽

Preliminary Study ◽

Newborn Intensive Care

A safe neonatal transport system is an essential component in the regionalization of perinatal care. Despite efforts to provide continuous intensive care to sick infants during transport,1-5 several studies have revealed an increased morbidity and mortality among infants transported to newborn intensive care units (NICU) compared with those infants born at the NICU.6,7 There is little information available about the adequacy of monitoring and maintaining oxygenation and acid-base status during infant transport. In a preliminary study we examined the ability of a neonatal transport team to maintain an infant's Pao2 (46 to 100 torr), pH (7.25 to 7.55), and Paco2 (20 to 50 torr) in the "physiologic" range during transport.

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The effect of aspirin, ticagrelor and heparin pre-transfer vs. similar precatherization treatment in STEMI on pre-PCI TIMI flow

European Heart Journal ◽

10.1093/ehjci/ehaa946.1833 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.A D'Entremont ◽

C Laferriere ◽

M Nguyen ◽

S Berube ◽

S Lepage ◽

...

Keyword(s):

Public Hospital ◽

Primary Outcome ◽

Bleeding Risk ◽

Funding Source ◽

Catheterization Laboratory ◽

Timi Flow ◽

Heparin Administration ◽

Peripheral Hospital ◽

Hospital Transfer ◽

Prehospital Triage

Abstract Aims Whether early combined antithrombotic therapy with aspirin, ticagrelor and unfractionated heparin (UFH) in STEMI patients can improve clinical outcomes is unknown. Data regarding the efficacy of UFH in this clinical setting is lacking. The objective of this novel study was to evaluate the effects of early pretreatment with aspirin, ticagrelor and UFH on pre-PCI TIMI flow in the IRA in acute STEMI patients. Methods and results Between January 2015 and June 2018, we retrospectively compared 488 STEMI patients receiving aspirin, ticagrelor and UFH pretreatment in a spoke peripheral hospital before transfer (PHT) versus 233 prehospital triage setting (PTS) STEMI patients receiving in-ambulance aspirin, followed by ticagrelor and UFH pretreatment in the hub catheterization laboratory before PCI. The primary outcome was the presence of a pre-PCI TIMI flow 2–3 in the IRA. The median times from ticagrelor and UFH administration to angiography in the PHT group and in the PTS group were 80 minutes (95% CI: 68.5–93.9) and 10 minutes (95% CI: 5–15.5) respectively (p<0.0001). Inverse probability of treatment weighting was used to minimize differences between groups. Main results are shown in Table 1. Each 10-minute delay between ticagrelor and heparin administration and angiography was associated with a reduced pre-PCI TIMI flow (OR 0.89, 95% CI: 0.85–0.93). Conclusion STEMI patients receiving aspirin, ticagrelor and UFH before peripheral hospital transfer have a significantly greater pre-PCI TIMI flow 2–3 and a lower rate of definite in-hospital stent thrombosis compared to patients receiving in-ambulance aspirin in the prehospital setting followed by ticagrelor and heparin in the catheterization laboratory without greater bleeding risk. While prehospital triage with rapid primary PCI remains the preferred scenario for STEMI patients, a prompt UFH initiation may play a synergistic role with ticagrelor and aspirin in decreasing pre-PCI thrombus burden in the presence of organizational delays. Figure 1. Study Design and Main Results Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Université de Sherbrooke's Department of Medicine, Division of Cardiology

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Effects of Sex on Early Outcome following Repair of Acute Type A Aortic Dissection: Results from The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Aorta ◽

10.1055/s-0039-1687900 ◽

2019 ◽

Vol 07 (01) ◽

pp. 007-014

Author(s):

Raphaelle A. Chemtob ◽

Vibeke Hjortdal ◽

Anders Ahlsson ◽

Jarmo Gunn ◽

Ari Mennander ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Repair ◽

Multivariable Analysis ◽

Operation Time ◽

Postoperative Outcome ◽

Type A ◽

Operative Management ◽

Chronic Obstructive ◽

Acute Type ◽

Type A Aortic Dissection

Background Female sex is known to have increased perioperative mortality in cardiac surgery. Studies reporting effects of sex on outcome following surgical repair for acute Type A aortic dissection (ATAAD) have been limited by small cohorts of heterogeneous patient populations and have shown diverging results. This study aimed to compare perioperative characteristics, operative management, and postoperative outcome between sexes in a large and well-defined cohort of patients operated for ATAAD. Methods The Nordic Consortium for Acute Type A Aortic Dissection study included patients with surgical repair of ATAAD at eight Nordic centers between January 2005 and December 2014. Independent predictors of 30-day mortality were identified using multivariable logistic regression. Results Females represented 373 (32%) out of 1,154 patients and were significantly older (65 ± 11 vs. 60 ± 12 years, p < 0.001), had lower body mass index (25.8 ± 5.4 vs. 27.2 ± 4.3 kg/m2, p < 0.001), and had more often a history of hypertension (59% vs. 48%, p = 0.001) and chronic obstructive pulmonary disease (8% vs. 4%, p = 0.033) compared with males. More females presented with DeBakey class II as compared with males with dissection of the ascending aorta alone (33.4% vs. 23.1%, p = 0.003). Hypothermic cardiac arrest time (28 ± 16 vs. 31 ± 19 minutes, p = 0.026) and operation time (345 ± 133 vs. 374 ± 135 minutes, p < 0.001) were shorter among females. There was no difference between the sexes in unadjusted intraoperative death (9.1% vs. 6.7%, p = 0.17) or 30-day mortality (17.7% vs. 17.4%, p = 0.99). In a multivariable analysis including perioperative factors influencing mortality, no difference was found between females and males in 30-day mortality (odds ratio: 0.92, 95% confidence interval: 0.62–1.38, p = 0.69). Conclusions This study found no association between sex and early mortality following surgery for ATAAD, despite females being older and having more comorbidities, yet also presenting with a less widespread dissection than males.

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Acute Type A Aortic Dissection in a 36-Week Pregnant Patient

Case Reports in Emergency Medicine ◽

10.1155/2013/390670 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Erol Kohli ◽

Sharhabeel Jwayyed ◽

Gary Giorgio ◽

Mary Colleen Bhalla

Keyword(s):

Aortic Dissection ◽

Early Recognition ◽

Type A ◽

Pregnant Patient ◽

Acute Type ◽

Third Trimester ◽

Type A Aortic Dissection ◽

Increased Risk ◽

History Of ◽

Aortic Dissections

Aortic dissection is a relatively rare yet often fatal condition. Early recognition and treatment are crucial for survival. While the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, and a family history of aortic dissection are also at an increased risk for developing this condition. A review of the literature revealed a paucity of published cases describing the successful, emergent repair of acute type A aortic dissections in third- trimester gravid patients. We present the case of the successful diagnosis and surgical repair of a 41-year-old female who presented to the emergency department with an acute type A aortic dissection at 36 weeks of gestation.

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