TY - JOUR
T1 - Management of acute mesenteric ischaemia
T2 - Results of a worldwide survey
AU - Hess, Benjamin
AU - Cahenzli, Martin
AU - Forbes, Alastair
AU - Burgos, Rosa
AU - Coccolini, Federico
AU - Corcos, Olivier
AU - Holst, Mette
AU - Irtun, Øivind
AU - Klek, Stanislaw
AU - Pironi, Loris
AU - Rasmussen, Henrik H. jgaard
AU - Serlie, Mireille J.
AU - Thibault, Ronan
AU - Gabe, Simon
AU - Reintam Blaser, Annika
AU - Akin, Emrah
AU - Ali, Syed Muhammad
AU - Argenio, Giulio
AU - Atici, Semra Demirli
AU - Augustin, Goran
AU - Baili, Efstratia
AU - Bains, Lovenish
AU - Bala, Miklosh
AU - Baldini, Edoardo
AU - Baraket, Oussama
AU - Barone, Mirko
AU - Biloslavo, Alan
AU - Roberto Bini, null
AU - Bombardini, Cristina
AU - Brisinda, Giuseppe
AU - Buonomo, Luis
AU - Catena, Fausto
AU - Ceresoli, Marco
AU - Chiarello, Maria Michela
AU - Chouliaras, Christos
AU - D'Acapito, Fabrizio
AU - Damaskos, Dimitrios
AU - de Simone, Belinda
AU - Delogu, Daniele
AU - Demetrashvili, Zaza
AU - di Carlo, Isidoro
AU - D'Oria, Mario
AU - Durán-Muñoz-Cruzado, Virginia María
AU - Forget, Patrice
AU - Fortuna, Laura
AU - Fransvea, Pietro
AU - Frey, Christian
AU - Gapejeva, Olga
AU - Garcon, Pierre
AU - Gass, J. rn-Markus
AU - Teixeira Gonsaga, Ricardo Alessandro
AU - Griffiths, Ewen
AU - Gundogan, Kursat
AU - Gurjar, Mohan
AU - Hamid, Hytham K. S.
AU - Silesky Jiménez, Juan Ignacio
AU - Kase, Karri
AU - Hussain Kazmi, Syed Sajid
AU - Kechagias, Aristotelis
AU - Khokha, Vladimir
AU - Kobe, Yoshiro
AU - Korkolis, Dimitrios P.
AU - Litvin, Andrey
AU - Lostoridis, Eftychios
AU - Mahendran, Hans Alexander
AU - Marino, Fabio
AU - Martinuzzi, Andres
AU - Mesina, Cristian
AU - Neri, Vincenzo
AU - Panisic, Marina
AU - Paolillo, Ciro
AU - Pararas, Nikolaos
AU - Perrone, Gennaro
AU - Pesce, Antonio
AU - Picardi, Biagio
AU - Pither, Charlotte
AU - Podda, Mauro
AU - Poskus, Tomas
AU - Poullenot, Florian
AU - Przemyslaw, Matras
AU - Sartelli, Massimo
AU - Sasia, Diego
AU - Scheiterle, Maximilian
AU - Seretis, Fotios
AU - Søreide, Kjetil
AU - Sydorchuk, Ruslan
AU - Szczepanek, Kinga
AU - Bodnar, Zsolt
AU - Tamion, Fabienne
AU - Tarasconi, Antonio
AU - Teraa, Martin
AU - Tolonen, Matti
AU - Vanuytsel, Tim
AU - Veroux, Massimiliano
AU - Vinter-Jensen, Lars
AU - Visconti, Diego
AU - Widmer, Lukas
AU - Zakaria, Andee Dzulkarnaen
AU - Zubareva, Nadezhda
AU - Endorsing International Societies, null
AU - ESICM (European Society of Intensive Care Medicine), null
AU - WSES (World Society of Emergency Surgery), null
AU - WSACS (The Abdominal Compartment Society), null
AU - ESPEN Special Interest Group on Acute Intestinal Failure ESPEN (European Society for Clinical Nutrition and Metabolism)
AU - in-principle support, null
AU - WFICC (World Federation of Intensive and Critical Care), null
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/4/1
Y1 - 2023/4/1
N2 - 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.
AB - 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.
KW - Acute mesenteric infarction
KW - Acute mesenteric ischaemia
KW - Intestinal failure
KW - NOMI (Non-occlusive mesenteric ischaemia)
KW - Occlusive intestinal ischaemia
KW - Survey
KW - Treatment
UR - https://www.scopus.com/pages/publications/85147683537
U2 - 10.1016/j.clnesp.2022.12.022
DO - 10.1016/j.clnesp.2022.12.022
M3 - Article
C2 - 36963863
SN - 2405-4577
VL - 54
SP - 194
EP - 205
JO - Clinical nutrition ESPEN
JF - Clinical nutrition ESPEN
ER -