Looking for Statistic on Aneurysm Rupture Survival Rates

Bob Latino blatino at RELIABILITY.COM
Mon Apr 3 12:09:11 UTC 2017


Hi Thom

Thank you for your thoughtful response.  I am very happy to hear of Josh's success story, and can only imagine the torment your family went through.  In my friend's case he was not in the medical field so his only daughter's fate was left to the clinical professional's.  We often look to the 'Swiss Cheese Model' to express how a failure occurred, but as stated previously, in this case the Swiss Cheese Model showed how the holes lined up to produce a success.

I am not a clinician either but I know the rupture was at the base of the brain as well, but I do not know the size.  The surgery performed was via a catheter to place a stent.  The pooled blood was draining to the lower back and they told her to expect pain there and for the headaches to continue until the blood was absorbed by the body.

The patient was a very fit 35 y/o female.  She is a 'cross fit' competitor and was actually in the gym training when this occurred (her two kids in the nursery/play area). It took 12 minutes for the ambulance from the local professional fire station to arrive.  She was non-responsive for that full 12 minutes.  They diverted from going to the local hospital to the Level 1 Trauma Center in Richmond, VA, which is an inner-city, 1000+ bed teaching hospital.

I think the stars did align in her favor, and her two boys (8 and 6) still have their mother.  I hope she is as fortunate as Josh and continues to have a normal, productive and happy life.

Thanks for taking the time to address my inquiry, it means a lot.

Regards
Bob Latino

Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com
www.reliability.com



-----Original Message-----
From: Mayer, Thom [mailto:tmayer at best-practices.com] 
Sent: Saturday, April 01, 2017 1:12 PM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>; Bob Latino <blatino at reliability.com>
Subject: Re: [IMPROVEDX] Looking for Statistic on Aneurysm Rupture Survival Rates

Hi Bob

I'm an emergency physician who practices at a nationally recognized level 1 trauma center. Perhaps more importantly our oldest son, Josh, had a 5 cm basilar artery aneurysm so I know this territory fairly well and also discussed it with Josh's neurosurgeon 

The answer on prognosis of brain aneurysms is, like so much in medicine, "It depends."  In this case it depends on the size and location of the lesion, the speed of recognition, the patient's underlying health status, and the skill and experience of not only the the vascular neurosurgeon and/or interventional radiologist ( both of which are specialties unto themselves) but the team of people caring for her, including the EMS/paramedics who instantly recognized she needed specialty care

For brevity's sake, the prognosis ranges from extremely high for small, focal aneurysms which can often be treated with coils through a catheter in which > 90% survival with no or minimal deficits in young people to nearly uniformly poor results for massive hemorrhages or large brain stem aneurysms (like Josh's-although his story is great as I ll share).

So I would say she is a very lucky young lady on every front but the kind of work the team did is actually extremely common.  As an aside, the team undoubtedly uses the principles of crew resource management as virtually all trauma centers do

And Josh's case was discussed by all of the best vascular neurosurgeons in the world. Only one, Dr Robert Spetzler of Barrow Neurological Institute, would even consider operating since the basilar artery feeds the brain stem and the entire artery was an aneurysm 

Not to get too technical but he clipped BOTH vertebral arteries, diverting all anterograde flow through the collateral circulation creating retrograde flow, thereby keeping precisely the right amount of flow to clot the aneurysm but keep the basilar artery open. For the docs on the thread, that is a bold and stunning move that very few docs could pull off

And despite a sometimes rocky post-op course, Josh is 12 years out, married with 3 lovely daughters my wife and I enjoy every weekend!

Hope this helps

My best to your friend and his daughter 

I rarely post but I enjoy the discussion 

Best

Doc
Thom Mayer MD
Medical Director
NFL Players Association 

Sent from my iPhone

> On Mar 31, 2017, at 5:14 PM, Bob Latino <blatino at RELIABILITY.COM> wrote:
> 
> Good point!  How does the initial Dx of first responders (if at all) influence the initial Dx of the receiving ED physician, when time is of the essence?
> 
> I didn't know if Neurosurgeons participated on this forum, but I thought I would check.
> 
> Thanks
> 
> Robert J. Latino, CEO
> Reliability Center, Inc.
> 1.800.457.0645
> blatino at reliability.com
> www.reliability.com
> 
> 
> 
> -----Original Message-----
> From: Hueth, Kyle D. [mailto:kyle.hueth at aruplab.com]
> Sent: Friday, March 31, 2017 10:42 AM
> To: Society to Improve Diagnosis in Medicine 
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>; Bob Latino 
> <blatino at reliability.com>
> Subject: Re: [IMPROVEDX] Looking for Statistic on Aneurysm Rupture 
> Survival Rates
> 
> Wow! What a fortunate outcome.  I'm interested to hear the answer to your question and would like to pose another.
> 
> Is there data on the appropriate initial diagnosis/evaluation by emergency responders when it comes to determining the level of care a patient will need, as was the differentiator in this case?  Outcomes tied to this early factor would be interesting to know.
> 
> Best,
> 
> Kyle Dean Hueth, MLS(ASCP)
> Healthcare Consultant
> 
> Sent from my iPhone
> 
> On Mar 31, 2017, at 05:45, Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>> wrote:
> 
> Two weeks ago, a good friend of mine's daughter suffered the rupture of an aneurysm at 35 y/o.  She was nonresponsive for 12 minutes and transported to our local Trauma 1 hospital which was about 40 minutes.  Brain surgery was performed within 8 hours of arrival at the hospital to put a stent in place.
> 
> Amazingly she 1) survived, 2) will be released from the hospital tomorrow and 3) has no apparent deficits at this time.  She still has to take it very slow (she is very fit Physical Therapist) for about 4 months and has residual headaches which will reportedly fade in due time.
> 
> Does anyone have any stats of the survival rates of such a traumatic event and to survive with no apparent deficits?
> 
> The family is obviously overwhelmingly grateful to God and the hospital staff, but I was curious as to how uncommon it is to survive an aneurysm?
> 
> This is related to SIDM in a sense because the initial belief was that she was having a seizure (epilepsy ran in the family).  They were going to transport her to the local hospital which would not have been able to properly treat a ruptured aneurysm (and the time delay likely would have killed her) in a timely manner.
> 
> The Emergency Crew staff recognized the acuity of her case and decided to transport her to the Trauma 1 center a farther distance away.  Luckily it was the right decision.
> 
> Thanks for any feedback on this question.
> 
> Bob Latino
> 
> Robert J. Latino, CEO
> Reliability Center, Inc.
> 1.800.457.0645
> blatino at reliability.com<mailto:blatino at reliability.com>
> www.reliability.com<http://www.reliability.com>
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