Mean time to intubation(s) across UGY, PGY, R and VS using different intubation devices.

Error bars represent ±1 SE.</p

Time for intubation attempts and peak force applied on incisor and tongue across seniority using different devices in various scenarios.

Mean and 95% CI are presented. (DOCX)</p

Flowchart of steps in teaching and learning endotracheal intubation.

Flowchart of steps in teaching and learning endotracheal intubation.</p

Mean time to intubation(s) across UGY, PGY, R and VS in different intubation scenarios.

Error bars represent ±1 SE.</p

Cormack Lehane grade across seniority using direct laryngoscopy in various scenarios.

Cormack Lehane grade across seniority using direct laryngoscopy in various scenarios.</p

Mean peak force (N) applied on incisors across UGY, PGY, R and VS in different intubation scenarios.

Error bars represent ±1 SE.</p

Logistic regression analyses for in-hospital mortality.

Logistic regression analyses for in-hospital mortality.</p

Annual cases in the overall cohort, survivor group, and non-survivor group during the study period.

Annual cases in the overall cohort, survivor group, and non-survivor group during the study period.</p

Postoperative mortality and morbidity according to patient group.

Postoperative mortality and morbidity according to patient group.</p

Surgical information according to patient group.

BackgroundAcute type A aortic dissection (ATAAD) is a critical cardiovascular emergency that requires prompt surgical intervention for preserving life, particularly in patients with critical preoperative status. This retrospective study aimed to investigate the clinical features, early and late outcomes, and prognostic factors in patients undergoing aortic repair surgery for ATAAD complicated with preoperative shock.MethodsBetween April 2007 and July 2020, 694 consecutive patients underwent emergency ATAAD repair at our institution, including 162 (23.3%) presenting with preoperative shock (systolic blood pressure ResultsThe in-hospital surgical mortality rate in patients with ATAAD and shock was 22.8%. The non-survivor group showed higher rates of preoperative cardiopulmonary resuscitation, acute myocardial infarction, and cerebral infarction, and was associated with longer cardiopulmonary bypass time, higher rates of total arch replacement and intraoperative extracorporeal membrane oxygenation implementation. The non-survivor group had higher blood transfusion volumes and rates of malperfusion-related complications. Multivariate analysis revealed that preoperative cardiopulmonary resuscitation, prolonged cardiopulmonary bypass time, and total arch replacement were risk factors for in-hospital mortality. For patients who survived to discharge, the 5-year cumulative survival and freedom from aortic reoperation rates were 75.6% (95% confidence interval, 67.6%–83.6%) and 82.6% (95% confidence interval, 74.2%–91.1%), respectively.ConclusionsPreoperative shock in ATAAD is associated with a high risk of in-hospital mortality, particularly in patients who undergo cardiopulmonary resuscitation and complex aortic repair procedures with extended cardiopulmonary bypass. However, late outcomes are acceptable for patients who were stabilized through surgical treatment and survived to discharge.</div