Early Impact of an Aortic Alert for Ruptured Abdominal Aortic Aneurysm in a Rural Health System
Michael J Wilson, Nethaniel Darvishzadeh, Silviu Marica, Matthew Chang, Michele M McGowan, Lawrence Sampson, Amber S HussainAbstract
Introduction:
A ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition that requires immediate surgery. Survival depends on the operation itself and how quickly hospitals recognize the emergency, move the patient to the operating room, and assemble the necessary care teams. In rural health systems, these steps are often slowed by long-distance transfers and unclear communication. This study describes the creation of a standardized protocol and examines its early impact on care delivery.
Methods:
We developed an rAAA Alert Protocol to standardize communication, speed patient transfer, and prepare the operating room and blood bank before patient arrival. To assess impact, we used a retrospective observational cohort (2010-2024) to define preprotocol performance, including in-hospital mortality and door-to-intervention time for rAAA. We also examined length of stay and reviewed postimplementation cases in 2025 to assess changes in response time.
Results:
Before protocol implementation, 34 patients underwent operative repair for rAAA. In-hospital mortality was 38.2%, and the mean door-to-intervention time was 96.7 minutes. After implementation of the protocol, teams coordinated more quickly, with surgery beginning within 30 and 36 minutes of hospital arrival, and 2 patients with confirmed ruptures survived to discharge.
Discussion:
The creation of a rAAA Alert Protocol resulted in reductions in treatment delays and improved operational coordination within a rural health system. Although early outcomes are limited by sample size, the magnitude of improvement suggests that protocol-driven activation can improve readiness and response for time-critical vascular emergencies. Ongoing prospective evaluation is warranted to assess sustainability and long-term impact.