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Global study highlights varied incidence of acute mesenteric ischemia (AMI) and challenges in case ascertainment, emphasizing the urgent need for increased awareness, improved diagnostic guidance, and enhanced management strategies due to common pre-hospital delays and high mortality rates, often associated with surgery without revascularization.
The following is a summary of “Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study),” published in the January 2024 issue of Critical Care by Blaser et al.
Researchers performed a retrospective study to map the incidence, patient demographics, diagnosis, treatment, and prognosis of acute mesenteric ischemia (AMI).
They included all adult patients with clinical suspicion of AMI who were admitted or transferred to 32 participating hospitals (06.06.2022 to 05.04.2023). Participants without AMI or with localized intestinal gangrene due to strangulating bowel obstruction had data collected only at baseline and outcome.
The results showed AMI occurred in 0.038% of adult admissions across global acute care hospitals participating in the study. Of the 705 patients, 418 had confirmed AMI, with 69% presenting it as the primary reason for admission and 31% developing it post-admission with another diagnosis. The median time from symptom onset to hospital admission was 24 hours (with an IQR of 9-48 hours), and the time from admission to diagnosis was 6 hours (ranging from 1 to 12 hours). Diagnosis revealed occlusive arterial AMI in 231 patients (55.3%), venous AMI in 73 patients (17.5%), non-occlusive (NOMI) in 55 patients (13.2%), another type in 11 patients (2.6%), and the subtype could not be classified in 48 patients (11.5%). Initial management involved surgery in 242 patients (58%), with 59 of them (24.4%) undergoing revascularization. Endovascular revascularization was done in 54 patients (13%), conservative treatment was done in 76 patients (18%), and palliative care was done in 46 patients (11%). Among those with occlusive arterial AMI, revascularization was done in 104 patients (45%), with 40 (38%) treated at specific sites admitting selected patients. The overall in-hospital and 90-day mortality rates for AMI were 49% and 53.3%, respectively. Variability among participating sites was evident in the mortality rates of different AMI subtypes, with venous AMI showing the lowest mortality (13.7% and 16.4%) and NOMI displaying the highest (72.7% and 74.5%).
Conclusion: The overall incidence of AMI and AMI subtypes varies worldwide, and case ascertainment is challenging. Pre-hospital delay in presentation was greater than delays after arriving at hospital. Surgery without revascularization was the most common management approach. Nearly half of the patients with AMI died during their index hospitalization. Together, these findings suggest a need for greater awareness of AMI, and better guidance in diagnosis and management.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04807-4