Acute type A aortic dissection with cardiopulmonary arrest at presentation.

Abstract Background Management of acute type A aortic dissection (AADA) presenting with cardiopulmonary arrest (CPA) may require aggressive cardiopulmonary resuscitation (CPR), including extracorporeal CPR (ECPR) followed by aortic repair. This study evaluated the early and long-term outcomes of the patients with preoperative CPA related to AADA. Methods Between 9/2003 and 8/2019, 474 patients with AADA brought to our hospital, 157 (33.1%) presenting with CPA. Their mean age and prevalence of out-of-hospital CPA was 74.3±11.3 years and 90%, respectively, and causes of CPA included cardiac tamponade in 75%, hemothorax in 10%, and coronary malperfusion in 10% of cases. In the same time periods, 2974 patients of CPA were transported, and AADA was 4.8% of all cause of CPA. Results Return of spontaneous circulation (ROSC) was achieved in 26(17%), and ECPR was required in 31(20%); 131(83%) of CPA patients died before surgery, 24(15%) underwent aortic repair and 2(1%) received non-surgical care. Hospital mortality was 90% and none survived without aortic repair. Of patients achieving ROSC, 17 underwent aortic repair, 13 survived and 5 fully recovered. All patients with ECPR died; 24 before surgery and 7 postoperatively. There were significant differences in hospital mortality between patients who did and did not undergo aortic repair (p Conclusions AADA with CPA is associated with significantly high mortality, however, aortic repair can be performed with a 30% likelihood of functional recovery, if ROSC was achieved. Preoperative ECMO is not recommended in this patient cohort.