Table 3

List of statements reaching consensus in the third and final Delphi round

StatementProportion of respondents in agreement (%)
Round 1Round 2Round 3
Who should make the referral to the specialist aortic centre:
 Registrar or equivalent879091
 Registrar or equivalent should receive the call and arrange admission at the aortic centre929293
Patient may bypass the nearest hospital (non-aortic centre) and be taken directly to the aortic centre if:
 Aortic centre has an emergency department586681
 Patient has typical new symptoms suggesting acute aortic syndrome and pre-existing aortic disease727984
 Patient has typical new symptoms suggesting acute aortic syndrome and has had previous aortic intervention758691
Criteria required prior to considering transfer:
 Assessing clinician considers symptoms and signs of acute aortic syndrome are likely/possible637483
 Pre-existing aortic disease with typical new symptoms suggesting acute aortic syndrome678188
 Known pregnancy and typical new symptoms suggesting acute aortic syndrome617486
 CT scan of whole aorta889895
 CT scan of whole aorta reported by a radiologist698784
There is no age limit at which transfer for acute aortic syndrome would be inappropriate—always discuss with the aortic centre818596
Transfer to the aortic centre would be appropriate for patients with:
 No or minimal systemic disease9499100
 Moderate systemic disease939898
 Severe systemic disease485272
Transfer to the aortic centre would be appropriate for patients who:
 Are independent88100100
 Need some help with daily living909698
 Require institutional care for mental illness586780
 Always discuss with aortic centre708191
What patient condition would be appropriate for transfer:
 Alert and talking96100100
 Obeying commands9499100
 Fluctuating consciousness889295
 Shock requiring ongoing intervention717685
Which investigations should be completed in the initial assessment of a patient with confirmed acute aortic syndrome:
 Full blood count758592
 Urea and electrolytes768796
 Arterial or venous blood gas measurement809398
 CT scan of the whole aorta889896
Which treatments are reasonable to expect during transfer:
 Blood pressure support (pharmacological or intravenous fluids)879698
 Blood pressure reduction (pharmacological)879398
 Blood transfusion617278
 Airway should be managed with appropriate expertise (including ability to intubate if required)798491
What patient monitoring should be reasonably expected during transfer:
 Intermittent vital sign monitoring (pulse, blood pressure, temperature, saturations, respiratory rate, conscious level)758793
 Continuous vital sign monitoring839895
What if a patient had a cardiac arrest during transfer:
 Manage as per basic life support (BLS) principles616978
 Manage as per advanced life support principles (as BLS plus airway/drugs/defibrillation if indicated)768293
 Manage as per the discussion with the aortic centre* that occurred prior to transfer849392
How should the patient be transferred:
 Category 1 Ambulance—life-threatening (≤7 min response time)829598
 Category 2 Ambulance—time critical (≤18 min mean response time)698787
 Adult Critical Care Transfer Service677681
What would be an appropriate skill mix for transfer:
 Paramedics and nurse486174
 Paramedics and doctor677580
 Transfer-trained nurse658185
 Transfer-trained doctor748186
 Adult Critical Care Transfer Service728791
What facilities should be available prior to transfer at the aortic centre:
 ED resuscitation bed607078
 Access to CT scan and radiologist849292
 Access to ECG gated CT scan475975
 Emergency endovascular facility with 24/7 on call team (including IR consultant)819293
 Operating theatre839395
 Operating theatre with enhanced imaging facilities and ability to perform endovascular interventions748483
What should be the time frame for referral following diagnosis:
 Less than 30 min8996100
 30–60 min768395
What should be the time frame for agreed patient transfer commencing following diagnosis:
 Less than 30 min839495
 30–60 min879294
What should be the time frame for arrival at the aortic centre following diagnosis:
 30–60 min809089
 1–4 hours657781
  • The proportion of respondents in agreement has been shown for each round and was defined the proportion of participants in either agreement or strong agreement with a given recommendation. Rounds 1, 2 and 3 were completed by 212, 101 and 58 individuals, respectively. Adult Critical Care Transfer Service was defined as high-quality consultant-led care, co-ordination, triage and decision-support throughout the referral and transfer process between hospitals for all critically ill patients.