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Review
. 2021 Dec 23:38:100934.
doi: 10.1016/j.ijcha.2021.100934. eCollection 2022 Feb.

Incidence of acute aortic dissections in patients with out of hospital cardiac arrest: A systematic review and meta-analysis of observational studies

Ryan Gouveia E Melo  1   2   3 , Carolina Machado  2 , Daniel Caldeira  2   3   4   5   6 , Mariana Alves  2   4   5   7 , Alice Lopes  1   3 , Maria Serrano  2   8 , Ruy Fernandes E Fernandes  1   2   3 , Luís Mendes Pedro  1   2   3
Affiliations
Review

Incidence of acute aortic dissections in patients with out of hospital cardiac arrest: A systematic review and meta-analysis of observational studies

Ryan Gouveia E Melo et al. Int J Cardiol Heart Vasc. .

Abstract

Objectives: Acute Aortic dissection (AAD) may present as out-of-hospital cardiac arrest (OHCA). However, the incidence of this presentation is not well known. Our aim was to perform a systematic review and meta-analysis of all observational studies reporting on the incidence of AAD in patients with OHCA.

Methods: We searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey databases from inception to March-2021, for observational studies reporting on the incidence of AAD in patients with OHCA. Data was pooled using a random-effects model of proportions. The primary outcome was the incidence of AAD in OHCA patients. Secondary outcomes were the incidence of type A aortic dissections (TAAD) and type B aortic dissections (TBAD) in OHCA patients, overall mortality following AAD-OHCA and risk of death in AAD-OHCA patients compared to risk of death of non-AAD-OHCA patients.

Results: Fourteen studies were included. The pooled calculated incidence of OHCA due to AAD was 4.39% (95 %CI: 2.55; 6.8). Incidence of OHCA due to TAAD was 7.18% (95 %CI: 5.61; 8.93) and incidence of OHCA due to TBAD was 0.47% (95 %CI: 0.18; 0.85). Overall mortality following OHCA due to AAD was 100% (95 %CI: 97.62; 100). The risk of death in AAD-OHCA patients compared with non-AAD-OHCA patients was 1.10 (95 %CI: 0.94; 1.30).

Conclusion: AAD as a cause of OHCA is more frequent than previously thought. Prognosis is dire, as it is invariably lethal. These findings should lead to a higher awareness of AAD when approaching a patient with OHCA and to future studies on this matter.

Keywords: Aortic dissection; Incidence; Meta-analysis; Out-of-hospital cardiac arrest; Systematic review.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Pooled incidence of acute aortic dissection (AAD) in patients with out-of-hospital cardiac arrest (OHCA) in observational studies. Data is expressed as the percentage of OHCA due to AAD, with respective 95% confidence interval (CI). Result: 4.39% (95% CI: 2.55; 6.8; I2 95%).
Fig. 3
Fig. 3
A: Incidence of type A acute aortic dissection (TAAD) in patients with out-of-hospital cardiac arrest (OHCA). Data is expressed as the percentage of OHCA due to TAAD with respective 95% confidence interval (CI). Result: 7.18% (95% CI: 5.61; 8.93; I2 46%). B: Incidence of type B acute aortic dissection (TBAD) in patients with OHCA. Data is expressed as the percentage of OHCA due to TBAD, with respective 95% confidence interval (CI). Result: 0.47% (95% CI: 0.18; 0.85; I2 0%).
Fig. 4
Fig. 4
Overall mortality following out-of-hospital cardiac arrest (OHCA) due to acute aortic dissection (AAD). Data is expressed in percentage, with respective 95% confidence interval (CI). Result: 100% (95% CI: 97.62; 100; I2 40%).
Fig. 5
Fig. 5
Risk ratio of death in out-of-hospital cardiac arrest due to acute aortic dissection (AAD- OHCA) when compared to death in out-of-hospital cardiac arrest due to other intrinsic causes (non-AAD OHCA). Data is expressed in risk ratio, with respective 95% confidence interval (CI). Result: 1.10 (95% CI: 0.94; 1.30; I2 0%).
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