Expanding the trauma code to other causes of hemorrhagic shock — ruptured abdominal aortic aneurysms

Expanding the trauma code to other causes of hemorrhagic shock — ruptured abdominal aortic aneurysms

Can J Surg 2019;62(1):E17-E18 | PDF

Cyrus Chehroudi,* MD; Jason Patapas,* MD,CM, MSc; Jacinthe Lampron, MD; Prasad Jetty, MD,CM, MSc

Summary

Expediting life-saving care for hemorrhagic shock through multi-disciplinary code protocols is a potential method to improve outcomes. Trauma codes have become standard of care at most tertiary care centres; however, it is unclear if similar protocols can improve delivery of care for other forms of hemorrhagic shock. We examined the feasibility of a code protocol for ruptured abdominal aortic aneurysms (RAAAs) by reviewing the literature and comparing patient outcomes for RAAA and trauma patients at our institution, where the latter have a wellestablished trauma code protocol. We show that, despite being similarly unstable, patients with RAAA experienced delays to care milestones compared with trauma patients, even when accounting for diagnostic delays. Combining these data with present understanding of factors implicated in RAAA survival, we propose that a “CodeAAA” protocol may fill an important gap in RAAA care and that further prospective studies examining the utility of such a code are warranted.


*These authors contributed equally to this work.

Accepted July 27, 2018

Affiliations: From the Division of Vascular and Endovascular Surgery, The Ottawa Hospital, Ottawa, Ont. (Chehroudi, Jetty); and the Division of General Surgery, The Ottawa Hospital, Ottawa, Ont. (Lampron).

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.018717

Correspondence to: P. Jetty, 1053 Carling Ave., Ottawa ON K1Y 4E9, pjetty@toh.ca