Abdominal compartment syndrome and ruptured aortic aneurysm: Validation of a predictive test (SCA-AAR)

Betty Leclerc, Lucie Salomon Du Mont, Anne-Laure Parmentier, Guillaume Besch, Simon Rinckenbach, Betty Leclerc, Lucie Salomon Du Mont, Anne-Laure Parmentier, Guillaume Besch, Simon Rinckenbach

Abstract

Background: The abdominal compartment syndrome (ACS) has been clearly identified as being one of the main causes of mortality after ruptured abdominal aortic aneurysm (rAAA). The ACS is defined as a sustained intra-abdominal pressure > 20 mm Hg associated with a new organ dysfunction or failure. A pilot study was conducted and found that the threshold of 3 among 8 selected criteria, we would predict an ACS occurrence with a 54% positive predictive value and a 92% negative predictive value. But a multicentric prospective study was clearly needed to confirm these results. The outcome of this new study is to assess the qualities of a predictive test on occurrence of the ACS after rAAA surgery.

Methods: This is a 30 months prospective cohort study conducted in 12 centers and 165 patients will be included. All patients with a rAAA will be consecutively included, whatever the surgical treatment. At the end of surgery, all patients have an abdominal closure and a monitoring of intrabladder pressure will be established every 3 to 4 hours. Decompressive laparotomy will be indicated when ACS occurs. Follow-up period is 1 month. Eight pre- and per-operative criteria will be studied: anemia, hypotension, cardiac arrest, obesity, massive fluid resuscitation, transfusion, hypothermia, and acidosis.

Discussion: In the literature, there is no recommendation about prophylactic decompression, but early decompressive laparotomy appears to improve survival. This study should make it possible to establish a predictive test, detect the ACS early, and consider a prophylactic decompression in the operating room.

Trial registration: ClinicalTrials.gov, NCT02859662, Registered on 4 August 2016.

Conflict of interest statement

Competing interests: The authors declare that they have no competing interests.

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Schedule of enrolment, interventions and assessments.
Figure 2
Figure 2
Study design.

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Source: PubMed

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