Outcomes of acute type A aortic dissection with cardiopulmonary arrest: Tokyo Acute Aortic Super-Network Registry

Abstract Objectives Preventing loss of life in patients with acute type A aortic dissection presenting with cardiopulmonary arrest can be extremely difficult. Thus, we investigated the early outcomes in these patients. Methods Patients with acute type A aortic dissection that were transported to hospitals belonging to the Tokyo Acute Aortic Super-network between January 2015 and December 2019 were considered for this study. We assessed the early mortality of these patients presenting with cardiopulmonary arrest and also investigated the difference in outcomes between out-of-hospital and in-hospital cardiopulmonary arrest. Results In total, 3307 patients with acute type A aortic dissection patients were transported, of whom 434 (13.1%) patients presented with cardiopulmonary arrest. Overall mortality of patients presenting with cardiopulmonary arrest was 88.2% (383/434), of which 94.5% (240/254) experienced out-of-hospital cardiopulmonary arrest while 79.4% (143/180) experienced in-hospital cardiopulmonary arrest (p < 0.001). Multivariable analysis revealed that aortic surgery (odds ratio [OR], 0.022; 95% confidence interval [CI], 0.008 to 0.060; p < 0.001) and patient age over 80 years (OR, 2.946; 95% CI, 1.012 to 8.572; p = 0.047) were related with mortality in patients with acute type A aortic dissection patients and cardiopulmonary arrest. Between in-hospital and out-of-hospital cardiopulmonary arrest, the proportions of DeBakey type 1 (OR, 2.32; 95% CI, 1.065 to 5.054; p = 0.034), cerebral malperfusion (OR, 0.188; 95% CI, 0.056 to 0.629; p = 0.007), aortic surgery (OR, 0.111; 95% CI, 0.045 to 0.271; p = 0.001), age (OR, 0.969; 95% CI, 0.940 to 0.998; p = 0.039), and the time from symptom onset to hospital admission (OR, 1.122; 95% CI, 1.025 to 1.228; p = 0.012) were significantly different. Conclusions Patients with acute type A aortic dissection presenting with cardiopulmonary arrest exhibited extremely high rates of mortality. Patient outcomes following in-hospital cardiopulmonary arrest tended to be better than that following out-of-hospital cardiopulmonary arrest; however, this difference was not significantly different. Aortic surgery, when possible, should be considered in patients with acute type A aortic dissection who sustained cardiopulmonary arrest to prevent mortality.