A groundbreaking medical protocol implemented at Barcelona’s Hospital del Mar has dramatically reduced the mortality rate for one of the most lethal vascular emergencies: acute mesenteric ischaemia. Known colloquially as an intestinal infarction, this condition previously had an 82% mortality rate at the hospital. This figure has now plummeted to just 17% thanks to a new system prioritising rapid diagnosis and intervention.
Your browser does not support the video tag.
This protocol, considered the first of its kind in Spain and Southern Europe, marks a significant leap forward in treating a condition where time is critical. Acute mesenteric ischaemia occurs when blood flow to the intestines is suddenly blocked, often by a blood clot in the superior mesenteric artery. This blockage leads to tissue death. Without a restored blood supply within six hours, the condition frequently results in peritonitis, widespread infection, and fatal organ failure.
Across Catalonia, official figures record around 50 cases annually. However, experts believe the true number is much higher due to frequent delays in detection. The new approach at Hospital del Mar, a public medical centre on the city’s seafront, is now changing that narrative.
A Finnish Blueprint for Success
Dr. Ana María González, the hospital’s general surgeon and coordinator of traumatology and emergency surgery, spearheaded this initiative. Her inspiration came from a Finnish medical article detailing the success of a similar system at Helsinki University Central Hospital. This system had lowered its mortality rate to 25%, a figure far below the Spanish average.
Determined to see the system firsthand, Dr. González travelled to Helsinki. “It was January, in the middle of a cold snap, with temperatures of minus 30 degrees,” she recalled in comments reported by La Vanguardia. She added, “I was convinced. During a one-month stay, I saw that the results were incredible. They weren’t achieved by spending more resources, but by inverting the order and shortening all phases of both diagnosis and treatment.”
Upon her return, Dr. González worked to implement the “acute mesenteric ischaemia code” at her hospital. This institution was recently in the headlines after a thief was arrested on its premises for a phone robbery.
Reversing the Medical Playbook
The protocol’s success hinges on two fundamental changes to standard procedure. Firstly, it fosters early suspicion. Because the condition is rare and its primary symptom – intense abdominal pain – can be mistaken for other ailments, all hospital staff, from porters to surgeons, are now trained to recognise it as a red flag.
The second and most crucial change is a complete reversal of the typical diagnostic process. As Dr. González explained, “The usual procedure is to observe the patient, perform tests, observe more, and, if necessary, conduct more tests. In this case, it’s the opposite.”
Under the new code, a strong clinical suspicion immediately triggers an angio-CT scan. This imaging test uses a contrast dye to visualise blood vessels, confirming or ruling out the condition instantly, often before standard blood test results are even available. Dr. González noted, “The most difficult thing is performing the angio-CT before the analysis results, which is something no one had considered before.”
This approach mirrors the time-sensitive codes used for treating strokes, where every minute saved has a radical impact on patient outcomes. In its first year, Hospital del Mar activated the code 35 times, achieving a diagnosis in an average of just 17 minutes. The system proved highly effective: doctors diagnosed a serious surgical pathology in 92% of activations.
A New Standard of Care for Catalonia
The results have been nothing short of revolutionary. All patients diagnosed with intestinal infarction under the protocol maintained full intestinal integrity. In two cases, surgeons even managed to avoid a laparotomy, a major open surgery typically required. “This is a scenario that was practically unthinkable before the code’s application,” affirmed Dr. González.
Even when the team activated the code late, the mortality rate was 33% – still a vast improvement on the previous 82%. Dr. González believes the model is highly replicable, as its success relies on teamwork and reorganisation rather than expensive new technology. She emphasised, “One needs a person very interested in changing the reality, someone who knows how to work as a team and convince all specialities that this is the way to improve the prognosis.”
Now, Dr. González is leading a group with various Catalan scientific societies to extend the model to all hospitals in the region, aiming to standardise this life-saving care. “It is very unjust that depending on your postal code, one thing or another can happen to you,” she stated. “This is a deadly disease for which we can change the prognosis if we reorganise ourselves and think about it.”
