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Rapid diagnosis of aortic dissections could save many lives in Germany every year
A relatively unknown disease probably affects twice as many people as previously thought. The so-called acutely life-threatening aortic dissection leads to the death of hundreds of patients every year because it is detected too late or not at all. The researchers of the German Heart Center Berlin (DHZB) have now developed a concept for the coordination of diagnosis and treatment of the disease. This concept already led to a rescue of significantly more people in 2016 than in previous years.
The scientists of the German Heart Center Berlin (DHZB) found in their study that a new concept for the diagnosis and treatment of aortic dissection can save many lives each year. The doctors published a press release on the results of their study.
The so-called aortic dissection costs many lives every year in Germany. The disease is often treated by doctors as a heart attack, which additionally amplifies the bleeding. Improved diagnosis and treatment should now lead to fewer people dying from the disease. (Image: hriana / fotolia.com) What is an acute type A aortic dissection?
The complicated term "acute type A aortic dissection" stands for a life-threatening disease. In this, the inner wall layer of the main artery (aorta) tears directly to the heart and dissolves, explain the authors. The resulting gap fills with blood. The gap then increases along the aorta more and more. By this effect, branches of the aorta can be closed, the experts add.
Left untreated, the disease often leads to death within 48 hours
The biggest danger in an aortic dissection is the hemorrhage into the pericardium. Such a hemorrhage can quickly lead to cardiac arrest of those affected, the researchers warn. For this reason, the disease must be operated on as soon as possible in a specialized cardiac center. However, if the disease remains untreated, it will lead to the death of the patient within 48 hours in most cases, the authors explain.
Examination with a computer tomograph can detect the disease
Unfortunately, a quick and reliable diagnosis of acute aortic dissection is not straightforward. The symptoms (especially a severe chest pain) can even be misinterpreted by experienced paramedics as signs of a heart attack, the researchers explain. An examination with the computer tomograph (CT) can provide clarity. However, such a technology is not available on time everywhere.
Consequences of a wrong treatment
Treating an aortic dissection like a heart attack can have fatal consequences, explains Stephan Kurz from the DHZB. A heart attack is the result of a blood clot and is therefore treated with drugs that dilute the blood, say the doctors. In the aortic dissection, the bleeding is thus further accelerated. This can make the further supply much more difficult, adds the expert.
Physicians examined the data of more than 1,600 patients
For their study, researchers at the Department of Cardiothoracic and Vascular Surgery at the DHZB analyzed the patient records and emergency medical records of more than 1,600 patients treated for acute type A dissection. In addition, more than 14,000 autopsy reports from the Institute of Legal Medicine of the Charité and the Department of Pathology of the so-called Vivantes network were evaluated, the scientists report. The aim was to record how many patients in Berlin and Brandenburg died as a whole from an aortic dissection. The results of the investigation show that there is an urgent need for action.
An aortic dissection occurs more than twice as often as previously thought
It has been found that the median time from the onset of the first symptoms to the start of surgery is over eight hours. The researchers also found that aortic dissection is likely to occur much more often than previously thought. According to information from the Federal Statistical Office, there are 4.6 cases per year among 100,000 inhabitants. The extrapolation of the data collected in the study, however, gives more than twice the value (11.9 cases), explain the researchers. The scientists continue to report that they assume that more than 200 people have died in the disease every year in Berlin and Brandenburg. The reason for this is the late diagnosis or the wrong treatment of the acute aortic dissection, according to author Stephan Kurz.
Medical hotline to assist doctors
A medical hotline for all Berlin and Brandenburg physicians should now be available around the clock to coordinate and advise. The time from the event to the surgery is so significantly shortened. A specialist in anesthesia or cardiac surgery is available round the clock as a contact person for the staff of the regional rescue units, the scientists explain. On-site colleagues can be supported and, in addition, the preparation of the intervention at the DHZB is more effectively coordinated. Standard procedures were developed and agreed with the responsible emergency services, emergency physicians and emergency services, the doctors say. So these experts were further sensitized to the disease.
Processes have been optimized
The processes of admission, anesthesia, surgical care and further treatment in the intensive care unit at the DHZB were further improved and standardized, the authors report. An emergency website of the DHZB also provides guidelines for the faster transmission of patient data and treatment. The newly developed concept has already led to a significant improvement in the diagnosis and primary care of the aortic dissection, the researchers explain. The number of patients operated on acute type A dissection increased at the DHZB from an average of 80 cases in the previous years to 138 cases in 2016. This represents an increase of more than 70 percent. In addition, the time before the onset of the onset of symptoms could be reduced by an average of 20 percent, the authors explain. Normally many patients would not have survived without the improved diagnosis and efficient transfer to the DHZB, explains the clinic director Prof. Dr. med. Volkmar Falk.