System of care and time goals for intervention

The patient with a ruptured aneurysm. We suggest a door-to-intervention time of <90 minutes, based on a framework of 30-30-30 minutes, for the management of the patient with a ruptured aneurysm. Level of recommendation Good Practice Statement, Quality of evidence Ungraded

An established protocol for the management of ruptured AAA is essential for optimal outcomes. Level of recommendation Good Practice Statement, Quality of evidence Ungraded

We recommend implementing hypotensive hemostasis with restriction of fluid resuscitation in the conscious patient. Level of recommendation 1 (Strong), Quality of evidence B (Moderate)

We suggest that patients with ruptured AAA who require transfer for repair be referred to a facility with an established rupture protocol and suitable endovascular resources. Level of recommendation Good Practice Statement, Quality of evidence Ungraded

Initial operative management

If it is anatomically feasible, we recommend EVAR over open repair for treatment of a ruptured AAA. Level of recommendation 1 (Strong), Quality of evidence C (Low)