What Is the Role of Hypotensive Resuscitation/Damage Control Resuscitation in Ruptured AAAs?

Abstract

Ruptured abdominal aortic aneurysms (AAAs) have a high mortality. There have been few trials that examine the role of blood pressure management strategies prior to surgical repair of ruptured AAAs. Retrospective analyses have shown an association between higher volumes of crystalloid and colloid administration and mortality while controlling for key confounders. Permissive hypotension is a strategy used in trauma to avoid clot disruption, coagulopathy, hypothermia, and acidosis. International consensus guidelines recommend the use of permissive hypotension during the acute resuscitation of a patient with ruptured AAA, delaying aggressive fluid resuscitation until after surgical repair. A recommended approach for ruptured AAA management is (1) judicious fluid resuscitation targeting systolic blood pressure of 70-100 mmHg, (2) monitoring for impaired end-organ perfusion, and (3) emergent surgical intervention.