CV
CODE RUPTURE
THE PROCESS
At the inaugural meeting, a formal power point presentation was introduced outlining the objective, opportunities
for improvement, a proposed plan, evidence-based research, goals, and action items.
The presentation also included an algorithm flowchart to
give the team members a visual of the proposed plan. All
in attendance agreed to pursue creating a standardized
protocol to expedite treatment for patients presenting with
a rAAA.
Approximately 25 people representing all stakeholders
attended the meeting. Excitement began to brew which had
a synergistic effect as we all began to collaborate in building
the process.
Following the initial committee meeting, smaller sub-teams
were formed to pursue the following areas:
Patient Inclusion-Exclusion Criteria;
A guideline defining Code Rupture inclusion and exclusion
criteria was developed to provide a standard by which all
physicians could refer to decide the appropriateness of
initiating the Code Rupture protocol.
Inclusion criteria includes:
1. Any patient with a diagnostic study confirming a ruptured AAA.
2. Any patient with a known Abdominal Aortic Aneurysm
larger than 4cm or iliac artery aneurysm, and any of the
following: unexplained hypotension (clinical Impression); or new onset of unrelenting back, abdominal, or
flank pain.
CV DIRECTIONS VOL. 2, NO. 2
“It was determined that a
multidisciplinary team
approach was necessary...
Exclusion criteria includes:
1. Any patient or their designate who refused surgery.
2. Any patient deemed not a surgical candidate. Examples may include: severe dementia; residing in a skilled
nursing facility; or known terminal illness (ex. Hospice
patient with 3-12 months to end of life).
Communications;
Reliability and efficiency are two important characteristics
of the Code Rupture rapid response communication algorithm. Utilizing resources currently in use by the hospital’s
Code STEMI, Code Trauma, and Code Stroke protocols,
the communication algorithm utilizes as few personnel
resources as possible.
This algorithm includes a hemodynamic status update to
the surgical team while the patient is en-route. Once the
Code Rupture protocol is initiated, a burst page is delivered
to the entire team, including: air and ground transport
agencies; anesthesiology; perfusion; surgical services; the
cath team; radiology; the emergency department; patient
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