Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study)

Reintam Blaser A 1 , Mändul M 2 , Björck M 3 , Acosta S 4 , Bala M 5 , Bodnar Z 6 Show all authors , Casian D 7 , Demetrashvili Z 8 , D'Oria M 9 , Durán Muñoz-Cruzado V 10 , Forbes A 3 , Fuglseth H 11 , Hellerman Itzhaki M 12 , Hess B 13 , Kase K 3 , Kirov M 14 , Lein K 15 , Lindner M 16 , Loudet CI 17 , Mole DJ 18 , Murruste M 3 , Nuzzo A 19 , Saar S 20 , Scheiterle M 21 , Starkopf J 3 , Talving P 3 , Voomets AL 22 , Voon KKT 23 , Yunus MA 24 , Tamme K 3 , AMESI Investigators (Collaborators)

Affiliations 

  • 1 Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia. annika.reintam.blaser@ut.ee
  • 2 Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
  • 3 Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
  • 4 Department of Clinical Sciences, Lund University, Malmö, Sweden
  • 5 Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  • 6 Letterkenny University Hospital, Letterkenny, Ireland
  • 7 University Clinic of Vascular Surgery, "Nicolae Testemitanu" State University of Medicine and Pharmacy of the Republic of Moldova, Chişinău, Moldova
  • 8 N. Kipshidze Central University Hospital, Tbilisi, Georgia
  • 9 University Hospital of Trieste ASUGI, Trieste, Italy
  • 10 Virgen del Rocío University Hospital, Seville, Spain
  • 11 Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
  • 12 Intensive Care Unit and Institute for Nutrition Research, Rabin Medical Center, University of Tel Aviv, Petah Tikva, Israel
  • 13 Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
  • 14 Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University and City Hospital #1, Arkhangelsk, Russia
  • 15 University Hospital North Norway and UiT The Arctic University of Norway, Tromsö, Norway
  • 16 Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
  • 17 Hospital General San Martin de La Plata, Buenos Aires, Argentina
  • 18 Chair of Surgery, University of Edinburgh Centre for Inflammation Research, Royal Infirmary of Edinburgh, Edinburgh, UK
  • 19 Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, AP-HP. Nord, Beaujon Hospital, Paris Cité University, Paris, France
  • 20 Division of Acute Care Surgery, North Estonia Medical Centre, Tallinn, Estonia
  • 21 Azienda Ospedaliera Universitaria Careggi, Florence, Italy
  • 22 Tartu University Hospital, Puusepa 8, Tartu, Estonia
  • 23 Colorectal Surgery, Sarawak General Hospital, Kuching, Malaysia
  • 24 General Surgeon of General Surgery Department, Hospital Melaka, Malacca, Malaysia
Crit Care, 2024 Jan 23;28(1):32.
PMID: 38263058 DOI: 10.1186/s13054-024-04807-4

Abstract

BACKGROUND: The aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI).

METHODS: All adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI or had localized intestinal gangrene due to strangulating bowel obstruction had only baseline and outcome data collected.

RESULTS: AMI occurred in 0.038% of adult admissions in participating acute care hospitals worldwide. From a total of 705 included patients, 418 patients had confirmed AMI. In 69% AMI was the primary reason for admission, while in 31% AMI occurred after having been admitted with another diagnosis. Median time from onset of symptoms to hospital admission in patients admitted due to AMI was 24 h (interquartile range 9-48h) and time from admission to diagnosis was 6h (1-12 h). Occlusive arterial AMI was diagnosed in 231 (55.3%), venous in 73 (17.5%), non-occlusive (NOMI) in 55 (13.2%), other type in 11 (2.6%) and the subtype could not be classified in 48 (11.5%) patients. Surgery was the initial management in 242 (58%) patients, of which 59 (24.4%) underwent revascularization. Endovascular revascularization alone was carried out in 54 (13%), conservative treatment in 76 (18%) and palliative care in 46 (11%) patients. From patients with occlusive arterial AMI, revascularization was undertaken in 104 (45%), with 40 (38%) of them in one site admitting selected patients. Overall in-hospital and 90-day mortality of AMI was 49% and 53.3%, respectively, and among subtypes was lowest for venous AMI (13.7% and 16.4%) and highest for NOMI (72.7% and 74.5%). There was a high variability between participating sites for most variables studied.

CONCLUSIONS: 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.

TRIAL REGISTRATION: NCT05218863 (registered 19.01.2022).

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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