30-30-30 rule in AAA

Q: What is the 30-30-30 minutes rule for intervention in a ruptured Abdominal Aortic Aneurysm (AAA)?

Answer:  There is a certain mortality benefit for patients in symptomatic, ruptured or impending rupture AAA, if they are in teaching hospitals where such cases presents in a large number. The Society for Vascular Surgery guidelines recommends a "door-to-intervention" time of less than 90 minutes. 30-30-30 minutes rule 

1. From first medical contact to diagnosis and decision to transfer 
2. Rapid transport to the experienced facility, and 
3. Evaluation by the vascular team to arterial access and vascular control by aortic occlusion. 

 On side note, patients transferred on the weekend are reported to have higher adjusted mortality.

#surgical-critical-care


References:

1. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2. 

2.  Mell MW, Starnes BW, Kraiss LW, et al. Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm. J Vasc Surg 2017; 65:603. 

3.  Karthikesalingam A, Holt PJ, Vidal-Diez A, et al. Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA. Lancet 2014; 383:963. 

4.  Cho JS, Kim JY, Rhee RY, et al. Contemporary results of open repair of ruptured abdominal aortoiliac aneurysms: effect of surgeon volume on mortality. J Vasc Surg 2008; 48:10. 

5. O'Donnell TFX, Li C, Swerdlow NJ, et al. The Weekend Effect in AAA Repair. Ann Surg 2019; 269:1170.