Survey of the Routine Practice Limits for Physiologic and Technical Parameters Managed by Clinical Perfusionists during Adult Cardiopulmonary Bypass (original) (raw)
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Fundamental clinical skills of adult cardiopulmonary bypass: results of the 2017 national survey
Perfusion, 2018
Introduction: Training students to become entry-level perfusionists requires evaluation and assessment of their clinical skills. While our professional organizations have compiled resources which identify the profession's knowledge base and categorical skills applied to clinical practice, these resources are lacking the necessary detail to develop validated clinical assessment rubrics. Therefore, the purpose of this project is to identify, through expert opinion, the detailed fundamental skills necessary to perform adult cardiopulmonary bypass (CPB). Methods: We define a fundamental skill based upon frequency of use and risk of harm. A skill that experts report is conducted in >50% of their CPB cases-and, if not properly conducted, can cause harm, is deemed a fundamental skill. To identify these skills, a 73-question survey was developed and posted on PerfList and PerfMail from May 2017 to July 2017. Results: The results from 261 respondents were analyzed. The demographics of the participants were representative of the workforce. Twenty skills were surveyed and all 20 met the criteria to be identified as a fundamental skill. Data regarding the actions, assessments and behaviors that may be associated with fundamental skills were also identified. Conclusions: Based upon this survey data, we have identified that there is consensus within our profession regarding the fundamental skills of adult CPB and a core body of actions, assessments and behaviors that experts perform when conducting these skills. This information may be incorporated into the entry-level educational process to inform curricula and design valid assessment rubrics.
2000
Supplemental material is available online. C ardiopulmonary bypass (CPB) can be used during cardiac surgery to oxygenate and subsequently recirculate blood that has been diverted from the heart and lungs. The practice of CPB has changed-and continues to change-dramatically since its advent in the 1950s. Although structured reviews of the evidence supporting the practice of cardiac surgery have been in the literature for more than a decade and continue to be refined in the wake of new and emerging evidence, E1,E2 additional targeted reviews, focusing on issues such as minimizing the effect of the inflammatory response or minimizing neurologic injury, are warranted. E3-E5 Previous attempts, by Edwards and colleagues E6 and Bartels and associates, E7 at synthesizing the evidence base to support the principles of CPB have selectively reviewed the cardiac surgery literature or focused on unique patient populations. Additionally, the development of these reviews has not involved all members of the clinical team, most notably the individuals tasked with operating the CPB circuit. This gap in knowledge is in stark contrast with the shared goal of the cardiac team, namely to improve the conduct of CPB to reduce the patient's risk of adverse outcomes caused by cardiac surgery.
Developing a benchmarking process in perfusion: a report of the Perfusion Downunder Collaboration
The Journal of extra-corporeal technology, 2012
Improving and understanding clinical practice is an appropriate goal for the perfusion community. The Perfusion Downunder Collaboration has established a multi-center perfusion focused database aimed at achieving these goals through the development of quantitative quality indicators for clinical improvement through benchmarking. Data were collected using the Perfusion Downunder Collaboration database from procedures performed in eight Australian and New Zealand cardiac centers between March 2007 and February 2011. At the Perfusion Downunder Meeting in 2010, it was agreed by consensus, to report quality indicators (QI) for glucose level, arterial outlet temperature, and pCOz management during cardiopulmonary bypass. The values chosen for each QI were: blood glucose > or =4 mmol/L and < or =10 mmol/L; arterial outlet temperature < or = 37 degrees C; and arterial blood gas pCO2 > or =35 and < or =45 mmHg. The QI data were used to derive benchmarks using the Achievable Be...
Journal of Thoracic and Cardiovascular Surgery, 1995
The impact of perfusion technique and mode of pH management during cardiopulmonary bypass has not been well characterized with respect to postoperative cardiovascular outcome. Methods: This double-blind, randomized study comparing outcomes after alpha-stat or pH-stat management and pulsatile or nonpulsatile perfusion during moderate hypothermic cardiopulmonary bypass was undertaken in 316 patients undergoing coronary artery bypass operations. Results: Cardiovascular morbidity and mortality were not affected by pH management, and the incidence of stroke (2.5%) did not differ between groups. Overall in-hospital mortality was 2.8%, eight of the nine deaths occurring in the nonpulsatile group (5.1% versus 0.6%; p = 0.018). The incidence of myocardial infarction was 5.7% in the nonpulsatile group and 0.6% in the pulsatile group (p = 0.010), and use of intraaortic balloon pulsation was significantly more common in the nonpulsatile group (7.0% versus 1.9%; p = 0.029). The overall percentage of patients having major complications was also significantly higher in the nonpulsatile group (15.2% versus 5.7%; p = 0.006). Duration of cardiopulmonary bypass, age, and use of nonpulsatile perfusion all correlated significantly with adverse outcome. Conclusions: Use of pulsatile perfusion during cardiopulmonary bypass was associated with decreased incidences of myocardial infarction, death, and major complications. (J TnORAC CARDIOVASC SURG 1995;110:340-8)
2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery
European Journal of Cardio-Thoracic Surgery, 2019
The EACTS/EACTA/EBCP Guidelines represent the views of the EACTS, the EACTA and EBCP and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The EACTS, EACTA and EBCP are not responsible in the event of any contradiction, discrepancy and/or ambiguity between the EACTS, EACTA and EBCP Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EACTS, EACTA and EBCP Guidelines fully into account when exercising their clinical judgement as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the EACTS, EACTA and EBCP Guidelines do not, in any way whatsoever, override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do the EACTS, EACTA and EBCP Guidelines exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. The article has been co-published with permission in the
Supplemental material is available online. C ardiopulmonary bypass (CPB) can be used during cardiac surgery to oxygenate and subsequently recirculate blood that has been diverted from the heart and lungs. The practice of CPB has changed-and continues to change-dramatically since its advent in the 1950s. Although structured reviews of the evidence supporting the practice of cardiac surgery have been in the literature for more than a decade and continue to be refined in the wake of new and emerging evidence, E1,E2 additional targeted reviews, focusing on issues such as minimizing the effect of the inflammatory response or minimizing neurologic injury, are warranted. E3-E5 Previous attempts, by Edwards and colleagues E6 and Bartels and associates, E7 at synthesizing the evidence base to support the principles of CPB have selectively reviewed the cardiac surgery literature or focused on unique patient populations. Additionally, the development of these reviews has not involved all members of the clinical team, most notably the individuals tasked with operating the CPB circuit. This gap in knowledge is in stark contrast with the shared goal of the cardiac team, namely to improve the conduct of CPB to reduce the patient's risk of adverse outcomes caused by cardiac surgery.
The science and practice of cardiopulmonary bypass: From cross circulation to ECMO and SIRS
Global Cardiology Science and Practice, 2013
Perfusion": French verb 'perfuse' meaning to 'pour over'. Heart disease is a major health problem in the World, and heart surgery is now common for revascularisation in coronary artery disease, heart valve repair and replacements, and heart and heartlung transplantation. This includes surgery for adults with acquired heart disease and corrective and palliative surgery for both children (including neonates and infants) and adults with congenital heart conditions.