ACTACC Acute Type A Aortic Dissection Audit Form

Inclusion: Emergency/unplanned admission to hospital; arriving in theatre for repair of a Type A dissection/acute aortic syndrome. Includes patients who are stabilised for a period of time before operating; excludes iatrogenic dissections during other cardiac procedures.

Questions 4-14 may be best answered by the anaesthetising team; they can complete these and submit the form. The link-person can then complete the followup with a second form later. Please ensure the start of surgery and centre numbers match; these two questions require an answer before the form can be submitted. Alternatively paper forms may be preferred. Thanks in advance for your efforts!

Tom Gilbey and Gudrun Kunst, King's College Hospital, London

On behalf of the ACTACC committee.

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* 1. Which centre NUMBER was this patient anaesthetised in? (centres will be anonymised).

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* 2. Patient age (years)

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* 3. Patient sex

Female

Male

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* 4. Was this the first cardiac surgical centre to which they were referred?

Yes

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* 5. What was the reason for refusal at the first surgical centre (tick all that apply)?

Intensive care capacity

Theatre capacity

Staffing issues

Surgery deemed not in patient's best interests

Other (please specify)

Question not applicable or information not available

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* 6. Time of symptom onset

Date / Time

Date

Time

AM/PM

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* 7. Time of attendance to first hospital accident and emergency department

Date / Time

Date

Time

AM/PM

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* 8. What was the patient's GCS upon first presentation to A+E? (From 3-15)

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* 9. What was the patient's blood pressure upon first presentation to A+E? (systolic/diastolic in mmHg NB. note change from MAP for ease of reporting)

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* 10. Time of arrival at cardiac surgical centre

Date / Time

Date

Time

AM/PM

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* 11. Transfer team upon arrival at cardiac surgical centre (Please tick all that apply)

Nurse

Ambulance technician

Paramedic

Critical care paramedic

Doctor

Anaesthetist/Airway-trained doctor

Specialist transfer service i.e. regional critical care retrieval team or similar

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* 12. If accompanied by a doctor, what was the level of the most senior transferring doctor?

CT 1-3 "SHO" grade

ST 3-4 "Junior Registrar"

ST 5-7 "Senior Registrar or fellow"

Staff or Associate Specialist

Consultant

Not accompanied by a doctor

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* 13. Which of the following pharmacological treatments were ongoing upon arrival at your centre? (Please tick all that apply)

Supplemental oxygen therapy

Labetalol infusion

GTN infusion

Propofol infusion

Other (please specify)

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* 14. What forms of monitoring, support and vascular access were in place upon arrival at your centre? (Please tick all that apply)

ECG

Plethysmography/Oxygen saturations

End - tidal CO2 monitoring

Non-invasive blood pressure

Intra-arterial blood pressure

Central venous access

Intubated

Other (please specify)

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* 15. What was the patient's GCS upon arrival in theatre? (From 3-15)

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* 16. What was the patient's blood pressure upon arrival in theatre? (systolic/diastolic in mmHg NB. note change from MAP for ease of reporting)

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* 17. Investigations for diagnosis at first hospital

Echo

Other (please specify)

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* 18. Start of surgery (knife to skin)

Date / Time

Date

Time

AM/PM

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* 19. Surgical procedure (Please tick all that apply)

Aortic valve replacement

Aortic root replacement

Ascending aorta replacement

Hemi-arch replacement

Aortic arch replacement

Descending aortic procedure

Elephant trunk graft

Frozen elephant trunk graft

Concomitant CABG

Concomitant valve surgery

Re-do procedure

Other (please specify)

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* 20. Intraoperative technique (Please tick all that apply)

Selective antegrade cerebral perfusion

Retrograde cerebral perfusion

Axillary or innominate cannulation

Femoral cannulation

Seldinger aortic cannulation

Samurai cannulation

Bilateral cerebral oximetry

Unilateral cerebral oximetry

Bilateral depth of anaesthesia monitoring electrodes

Unilateral depth of anaesthesia monitoring electrodes

Tranexamic acid

Aprotinin

High dose intravenous steroids

Barbiturates

Phenytoin

DHCA

If DHCA, duration of DHCA in minutes:

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* 21. Lowest intraoperative temperature (°C)

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* 22. Intraoperative cross-clamp time (minutes; please enter 0 for a deliberate no-cross-clamp surgical technique)

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* 23. Please list blood products given in theatre (PRC, FFP and Cryo in units; platelets in pools; PCC in units, fibrinogen in mg; use question 31 for non-numeric input)

PRC

FFP or equivalent

Platelets

Cryoprecipitate

Prothrombin complex concentrate

Fibrinogen concentrate

Other

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* 24. Were there any significant delays (>1hr) during the patient's journey between onset of symptoms and admission to theatres?

Yes

If yes, please describe:

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* 25. Was there a significant clinical deterioration between presentation to accident and emergency in the first hospital and arrival in the operating theatre?

Yes

If yes, please describe to the best of your knowledge (for example GCS, haemodynamics).

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* 26. Did the patient die in hospital?

Yes

If yes, which post-operative day? (Day of surgery is day 0)

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* 27. Was there a second surgical intervention in the same admission?

Yes

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* 28. Length of ICU stay in days (ICU is any unit capable of delivering Level 3 care)

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* 29. Length of hospital stay in days (if repatriated ICU-ICU or ward-ward, discharged to a rehabilitation facility or otherwise lost to follow-up, please describe in Q31).

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* 30. Is there a history of known or suspected SARS-CoV-2 infection (defined as any of: persistent cough, fever, loss of smell or taste, positive PCR result) occurring on or after January 1st 2020?

Yes

Unknown

ACTACC Acute Type A Aortic Dissection Audit Form

Question Title

* 1. Which centre NUMBER was this patient anaesthetised in? (centres will be anonymised).

Question Title

* 2. Patient age (years)

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* 3. Patient sex

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* 4. Was this the first cardiac surgical centre to which they were referred?

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* 5. What was the reason for refusal at the first surgical centre (tick all that apply)?

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* 6. Time of symptom onset

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* 7. Time of attendance to first hospital accident and emergency department

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* 8. What was the patient's GCS upon first presentation to A+E? (From 3-15)

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* 9. What was the patient's blood pressure upon first presentation to A+E? (systolic/diastolic in mmHg NB. note change from MAP for ease of reporting)

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* 10. Time of arrival at cardiac surgical centre

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* 11. Transfer team upon arrival at cardiac surgical centre (Please tick all that apply)

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* 12. If accompanied by a doctor, what was the level of the most senior transferring doctor?

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* 13. Which of the following pharmacological treatments were ongoing upon arrival at your centre? (Please tick all that apply)

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* 14. What forms of monitoring, support and vascular access were in place upon arrival at your centre? (Please tick all that apply)

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* 15. What was the patient's GCS upon arrival in theatre? (From 3-15)

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* 16. What was the patient's blood pressure upon arrival in theatre? (systolic/diastolic in mmHg NB. note change from MAP for ease of reporting)

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* 17. Investigations for diagnosis at first hospital

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* 18. Start of surgery (knife to skin)

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* 19. Surgical procedure (Please tick all that apply)

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* 20. Intraoperative technique (Please tick all that apply)

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* 21. Lowest intraoperative temperature (°C)

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* 22. Intraoperative cross-clamp time (minutes; please enter 0 for a deliberate no-cross-clamp surgical technique)

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* 23. Please list blood products given in theatre (PRC, FFP and Cryo in units; platelets in pools; PCC in units, fibrinogen in mg; use question 31 for non-numeric input)

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* 24. Were there any significant delays (>1hr) during the patient's journey between onset of symptoms and admission to theatres?

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* 25. Was there a significant clinical deterioration between presentation to accident and emergency in the first hospital and arrival in the operating theatre?

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* 26. Did the patient die in hospital?

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* 27. Was there a second surgical intervention in the same admission?

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* 28. Length of ICU stay in days (ICU is any unit capable of delivering Level 3 care)

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* 29. Length of hospital stay in days (if repatriated ICU-ICU or ward-ward, discharged to a rehabilitation facility or otherwise lost to follow-up, please describe in Q31).

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* 30. Is there a history of known or suspected SARS-CoV-2 infection (defined as any of: persistent cough, fever, loss of smell or taste, positive PCR result) occurring on or after January 1st 2020?

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* 31. Anything else to record? Local hospital number, special clinical circumstances, correction to previous submission, caveats to data etc.