Level one vascular program reduces aortic emergency mortality

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When it comes to diseases and conditions affecting the cardiothoracic vasculature, every minute can make all the difference. Sudden aortic syndromes are life-threatening and require a highly-skilled, multidisciplinary team of physicians and resources. Through its level one vascular emergency program, Clarian Cardiovascular in Indianapolis has reduced time-to-treatment and mortality rates.

"In times of emergency, we have available the resources and treatment modalities at Clarian Cardiovascular that many outlying or referring hospitals do not," said John W. Fehrenbacher, MD, a cardiothoracic surgeon with Clarian Cardiovascular Surgeons. 

Clarian launched the level one vascular emergency program in August 2009 with a mission to improve clinical outcomes and the quality of care for patients with cardiothoracic and vascular conditions (acute thoracic aortic aneurysms and dissections, abdominal aortic aneurysms and acute limb ischemia). Clarian's program treats the emergent thoracic and abdominal aortic patient.

The foundation of the program is the one-call streamlined process. When an emergency room physician diagnoses a vascular emergency, that singular call prompts a number of actions, including:

  • Transportation for the patient, either by air or ground, to Methodist Hospital in Indianapolis;
  • Activation of the appropriate surgeons and treatment team;
  • Facilitation of physican-to-physican communication and nursing report; and
  • Guaranteed bed placement for the patient.

The level one vascular emergency program also utilizes current radiological technology that allows the physician to access and view the CT scan images from the referring facility prior to the patient's arrival. The accepting surgeon is then able to form the patient's treatment plan and to arrange the necessary support teams for the patient's arrival at Methodist. This approach, at times, enables the patient to go from the helicopter landing pad or triage ambulance bay directly to the operating room when appropriate.

"The importance of timely intervention for the treatment of a ruptured abdominal aortic aneurysm is illustrated by mortality rates. Nationally, this patient population has an 80 percent or greater out-of-hospital mortality rate, which decreases to about 50 percent if the patient makes it to the hospital. Yet, with our streamlined, rapid response program, we're seeing mortality rates of around 18-25 percent," said Michael Dalsing, MD, a vascular surgeon with Indiana University Vascular Surgery.

To date, the program has seen 60 activations from across the state, mostly with abdominal aortic aneurysms and acute thoracic dissections.