1. Management of acute mesenteric ischaemia: Results of a worldwide survey
- Author
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Benjamin Hess, Martin Cahenzli, Alastair Forbes, Rosa Burgos, Federico Coccolini, Olivier Corcos, Mette Holst, Øivind Irtun, Stanislaw Klek, Loris Pironi, Henrik Højgaard Rasmussen, Mireille J. Serlie, Ronan Thibault, Simon Gabe, Annika Reintam Blaser, Emrah Akin, Syed Muhammad Ali, Giulio Argenio, Semra Demirli Atici, Goran Augustin, Efstratia Baili, Lovenish Bains, Miklosh Bala, Edoardo Baldini, Oussama Baraket, Mirko Barone, Alan Biloslavo, null Roberto Bini, Cristina Bombardini, Giuseppe Brisinda, Luis Buonomo, Fausto Catena, Marco Ceresoli, Maria Michela Chiarello, Christos Chouliaras, Fabrizio D'Acapito, Dimitrios Damaskos, Belinda De Simone, Daniele Delogu, Zaza Demetrashvili, Isidoro Di Carlo, Mario D'Oria, Virginia María Durán-Muñoz-Cruzado, Patrice Forget, Laura Fortuna, Pietro Fransvea, Christian Frey, Olga Gapejeva, Pierre Garcon, Jörn-Markus Gass, Ricardo Alessandro Teixeira Gonsaga, Ewen Griffiths, Kursat Gundogan, Mohan Gurjar, Hytham K.S. Hamid, Juan Ignacio Silesky Jiménez, Karri Kase, Syed Sajid Hussain Kazmi, Aristotelis Kechagias, Vladimir Khokha, Yoshiro Kobe, Dimitrios P. Korkolis, Andrey Litvin, Eftychios Lostoridis, Hans Alexander Mahendran, Fabio Marino, Andres Martinuzzi, Cristian Mesina, Vincenzo Neri, Marina Panisic, Ciro Paolillo, Nikolaos Pararas, Gennaro Perrone, Antonio Pesce, Biagio Picardi, Charlotte Pither, Mauro Podda, Tomas Poskus, Florian Poullenot, Matras Przemyslaw, Massimo Sartelli, Diego Sasia, Maximilian Scheiterle, Fotios Seretis, Kjetil Søreide, Ruslan Sydorchuk, Kinga Szczepanek, Zsolt Bodnar, Fabienne Tamion, Antonio Tarasconi, Martin Teraa, Matti Tolonen, Tim Vanuytsel, Massimiliano Veroux, Lars Vinter-Jensen, Diego Visconti, Lukas Widmer, Andee Dzulkarnaen Zakaria, Nadezhda Zubareva, null Endorsing International Societies, null ESICM (European Society of Intensive Care Medicine), null WSES (World Society of Emergency Surgery), null WSACS (The Abdominal Compartment Society), null In-principle support, null WFICC (World Federation of Intensive and Critical Care), Endocrinology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Lucerne Cantonal Hospital [Luzern, Switzerland], University of Tartu, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Aalborg University [Denmark] (AAU), Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (MCMCC), Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO), Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Universiteit van Amsterdam (UvA), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), None, Hess, B, Cahenzli, M, Forbes, A, Burgos, R, Coccolini, F, Corcos, O, Holst, M, Irtun, Ø, Klek, S, Pironi, L, Rasmussen, H, Serlie, M, Thibault, R, Gabe, S, Reintam Blaser, A, Akin, E, Ali, S, Argenio, G, Atici, S, Augustin, G, Baili, E, Bains, L, Bala, M, Baldini, E, Baraket, O, Barone, M, Biloslavo, A, Roberto, B, Bombardini, C, Brisinda, G, Buonomo, L, Catena, F, Ceresoli, M, Chiarello, M, Chouliaras, C, D'Acapito, F, Damaskos, D, De Simone, B, Delogu, D, Demetrashvili, Z, Di Carlo, I, D'Oria, M, Durán-Muñoz-Cruzado, V, Forget, P, Fortuna, L, Fransvea, P, Frey, C, Gapejeva, O, Garcon, P, Gass, J, Teixeira Gonsaga, R, Griffiths, E, Gundogan, K, Gurjar, M, Hamid, H, Silesky Jiménez, J, Kase, K, Hussain Kazmi, S, Kechagias, A, Khokha, V, Kobe, Y, Korkolis, D, Litvin, A, Lostoridis, E, Mahendran, H, Marino, F, Martinuzzi, A, Mesina, C, Neri, V, Panisic, M, Paolillo, C, Pararas, N, Perrone, G, Pesce, A, Picardi, B, Pither, C, Podda, M, Poskus, T, Poullenot, F, Przemyslaw, M, Sartelli, M, Sasia, D, Scheiterle, M, Seretis, F, Søreide, K, Sydorchuk, R, Szczepanek, K, Bodnar, Z, Tamion, F, Tarasconi, A, Teraa, M, Tolonen, M, Vanuytsel, T, Veroux, M, Vinter-Jensen, L, Visconti, D, Widmer, L, Zakaria, A, Zubareva, N, Endorsing International, S, Institut Català de la Salut, [Hess B, Cahenzli M] Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland. [Forbes A] Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia. [Burgos R] Unitat de Suport Nutricional, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Coccolini F] General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy. [Corcos O] Intestinal Vascular Emergencies Structure (SURVI), Beaujon Hospital/Assistance Publique, Hopitaux de Paris, France, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Investigative Techniques::Epidemiologic Methods::Data Collection::Surveys and Questionnaires [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Occlusive intestinal ischaemia ,Nutrition and Dietetics ,Acute mesenteric ischaemia ,[SDV]Life Sciences [q-bio] ,Endocrinology, Diabetes and Metabolism ,NOMI (Non-occlusive mesentericandnbsp ,enfermedades del sistema digestivo::enfermedades gastrointestinales::enfermedades intestinales::isquemia mesentérica [ENFERMEDADES] ,Otros calificadores::/diagnóstico [Otros calificadores] ,Isquèmia intestinal - Tractament ,610 Medicine & health ,técnicas de investigación::métodos epidemiológicos::recopilación de datos::encuestas y cuestionarios [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Acute mesenteric infarction ,Intestinal failure ,Enquestes ,Treatment ,Isquèmia intestinal - Diagnòstic ,Other subheadings::/diagnosis [Other subheadings] ,NOMI (Non-occlusive mesenteric ischaemia) ,Survey ,Digestive System Diseases::Gastrointestinal Diseases::Intestinal Diseases::Mesenteric Ischemia [DISEASES] ,ischaemia) - Abstract
Background: Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide.Methods: A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected.Results: We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity.Conclusions: Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes. Background: Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide.Methods: A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected.Results: We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity.Conclusions: Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes.
- Published
- 2023
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