Guidelines on the diagnosis and management of acute aortic syndrome in emergency

Title: Guidelines on the diagnosis and management of acute aortic syndrome in emergency
Edition: Original
Classification: Standard guideline
Field: Diagnosis and Treatment
Countries and regions: China
Guidelines users: The recommendations of the guideline are applicable to clinical staff in all medical institutions who care for patients with acute aortic syndrome.
Evidence classification method: The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method is used to rate the body of evidence supporting recommendations, and the quality of the evidence is divided into four qualities: high (A), medium (B), low (C), and very low (D) level. Randomized controlled trials (RCTs) are considered high-quality evidence and observational studies are considered low-quality evidence. In the evidence grading process, 5 downgrading factors (risk of bias, consistency, indirectness, precision, and publication bias) and 3 upgrading factors (large effect size, confounding bias, and dose-response relationship) were considered. The evidence is finally presented through an evidence summary table.
Development unit: Chinese Society of Emergency Medicine, Chinese Medical Association; Chinese Society of cardiovascular surgery, China Physicians Association; Emergency Medicine Committee of China Medical Education Association
Registration time: 2023-09-22
Registration number: PREPARE-2023CN741
Purpose of the guideline: Acute aortic syndrome (AAS) is a group of cardiovascular diseases that seriously threaten human life and health. In recent years, with the popularization of imaging technologies such as multi-slice CT vascular imaging, the diagnosis rate of AAS has increased significantly. In order to standardize the clinical diagnosis and treatment of AAS, the American Heart Association issued guidelines for the diagnosis and treatment of thoracic aortic disease in 2010, and the European Society of Cardiology first issued guidelines for the diagnosis and treatment of aortic disease in 2001, and made recommendations on the guidelines in 2014. In 2017, the Macrovascular Surgery Professional Committee of the Cardiovascular Surgery Branch of the Chinese Physician Association formulated the "Chinese Expert Consensus on Diagnosis and Treatment Standards for Aortic Dissection" and further formulated the "Standards for Diagnosis and Treatment of Acute Aortic Syndrome" in 2021. Timely diagnosis and correct treatment can significantly reduce the mortality and complication rates of AAS. However, the overall incidence of AAS is relatively low, there is a lack of RCT studies, and the above guidelines/consensus are all issued by the cardiovascular committee, and the content mainly focuses on surgical treatment and surgical strategies. Up to now, there are no domestic diagnosis and treatment guidelines for emergency physicians in this field. Therefore, it is necessary to be oriented by clinical practice and application and focus on key clinical issues such as acute management, condition assessment, comorbidity management, and transportation of AAS, based on the current available evidence and national conditions, the "Guidelines on the Diagnosis and Treatment of Acute Aortic Syndrome in Emergency" (hereinafter referred to as the "Guidelines") were developed. This article is a proposal for the guideline. It will introduce in detail the methods, processes and precautions applicable to the guideline formulation, and provide a rigid and guiding document for the scientific and reasonable formulation of the guideline.