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Prognosis of critically ill patients with occlusive arterial acute mesenteric ischemia: the 5-year French experience of a dedicated mesenteric stroke center SURVI

Year: 2025

Type: article

Abstract: PURPOSE: In 2016, the first French intestinal stroke center (ISC) was created to provide standardized and multidisciplinary care of patients with acute mesenteric ischemia (AMI). Our aim is to describe Intensive Care Unit (ICU) patients with occlusive arterial acute mesenteric ischemia (OAAMI) hospitalized in the ISC. METHODS: Retrospective study including patients with OAAMI requiring ICU hospitalization from 2016 to 2021. The primary objective was to identify risk factors for 28-day and one-year mortality. Secondary objectives were to describe initial digestive and vascular management, and patient outcomes from ICU to one year. RESULTS: We enrolled 133 critically ill patients with OAAMI (78.2% thrombotic, 85.7% mesenteric artery culprit). Emergency laparotomy was performed in 108 (81.2%) patients, revealing extensive intestinal necrosis beyond any therapeutic resource in 14 (10.5%) patients and segmental intestinal necrosis requiring resection in 45 (33.8%) patients. Arterial revascularization was performed in 105 (78.9%) patients. 28-day and one-year mortality rates were 33.1% and 46.6%. Mortality risk factors were age, lactatemia at admission, and intestinal necrosis. Mortality rates of patients with three factors were 75% at Day 28 and 100% at one year. Intestinal failure concerned 59.8% of patients discharged alive from the ICU, but only 18.3% of survivors at one year still required parenteral nutrition. CONCLUSION: We report 28-day and one-year outcomes of critically ill patients with OAAMI, suggesting that ISC management based on a life- and gut-saving strategy management may improve prognosis. Identified risk factors may help to select patients who would really benefit from this aggressive strategy.

Source: Anaesthesia Critical Care & Pain Medicine

DOI: 10.1016/j.accpm.2025.101650