Controlled Hypotension in Patients Suspected of a Ruptured Abdominal Aortic Aneurysm: Feasibility during Transport by Ambulance Services and Possible Harm

Abstract 

Objective

To evaluate a controlled hypotension protocol for patients suspected of a ruptured aneurysm of the abdominal aorta (RAAA) and to identify possible harm to patients with a final diagnosis other than RAAA.

Design

Retrospective analysis of patients suspected of RAAA and transported by Amsterdam ambulance services between January 2006 and October 2007.

Patients and methods

Protocol was assessed by reviewing systolic blood pressure (<80mmHg, 80–100mmHg or >100mmHg), administered fluid volume and verbal responsiveness during transport. Patients who could possibly have been harmed by controlled hypotension were identified by final diagnoses.

Results

Fluid administration was according to protocol in 220 of 266 patients analysed for protocol adherence. The remaining patients received too much (21 patients) or too little fluid (25 patients). Data were missing in 29 patients. A RAAA was diagnosed in 81 (27%) of all 295 patients analysed for final diagnosis. Controlled hypotension was achieved in 10% of all patients and in 17% of patients with RAAA. Three patients (1%) with diagnosis other than RAAA were possibly at risk by implementing controlled hypotension.

Conclusions

Protocol was followed in 83% and protocol violations occurred in 17% of patients. The risk of implementing controlled hypotension for all patients suspected of an RAAA by the ambulance staff was low.

Keywords: Aneurysm, Ruptured, Aortic aneurysm, Abdominal, Hypotension, Controlled