ORIGINAL ARTICLE
Adult Clinical Perfusion Practice Survey : 2020 results
w
Breana Lohbusch ( BA )
1 , 2 , Kaylee Olson ( BS )
1 , 2 , Benjamin Magowan ( BS )
1 , 2 , Robert Cherichella ( BS )
1 , 2 , Jeremy Wolverton ( MS )
1 , 2 , Laura Dell ’ Aiera ( MHA , CCP )
1 , 2 ,
Donald S . Likosky ( PhD )
1 , 2 , and David Fitzgerald ( DHA , CCP )
1 , 2 ,*
1 Division of Cardiovascular Perfusion , College of Health Professions , The Medical University of South Carolina , Charleston , SC 29425 , USA 2 Department of Cardiac Surgery , The Center for Healthcare Outcomes & Policy ( CHOP ), University of Michigan Medical School , Ann
Arbor , MI 48109 , USA
Received 13 June 2022 , Accepted 11 January 2023
Abstract – Background : Cardiovascular perfusion is a dynamic healthcare profession where new practices are frequently introduced . Despite the emergence of evidence-based clinical practice guidelines , little is known about their dissemination at the institutional level . Clinical practice surveys have been used to identify current trends in perfusion practice in the areas of equipment , techniques , and staffing . This survey aims to describe clinical perfusion practices across adult cardiac surgical programs located in a large , single , geographical region of the United States . Methods : Following Institutional Review Board ( IRB ) approval , an 81-question survey was distributed to 167 adult perfusion programs across the Zone IV region of the American Society of Extracorporeal Technology ( AmSECT ), a non-profit professional society representing the extracorporeal technology community . Surveys were distributed to chief perfusionists through the Research Electronic Data Capture ( REDCap ) web-based survey response system . Results : Responses were received from 58 of 167 centers across ( 34.7 % response rate ). Centrifugal pumps were used at 81 % ( n = 47 ) of centers and 96.6 % ( n = 56 ) use an open venous system or hard-shell venous reservoir . Del Nido was the most frequently used cardioplegia strategy with 62.1 % ( n = 36 ) of centers reporting its use . The use of electronic medical records was reported in 43 % ( n = 25 ) of centers , while 84.5 % ( n = 49 ) reported using Cardiopulmonary Bypass ( CPB ) protocols (> 75 % of all CPB activities ). Extracorporeal Membrane Oxygenation ( ECMO ) support was reported in 93.1 % ( n = 54 ) of programs , with 59.2 % of programs ( n = 34 ) employing a perfusionist as ECMO Coordinator . The n + 1 staffing model was reported by 50 % ( n = 29 ), with 24 % supporting the n + 1 staffing for after-hours and on-call procedures . Conclusion : Clinical practice surveys can be effective tools to inform clinicians about contemporary perfusion practice and identify deviations from professional standards and guidelines . Subsequent surveys may describe trends over time , assess standardization of practice , measure adherence to evidence-based guidelines , and foster improved patient care and outcomes .
Key words : Clinical practice survey , Adult perfusion , Standards , Clinical practice guidelines , Variability .
Introduction
Cardiac surgery is one of the most performed inpatient operations in the United States [ 1 ]. Despite large-scale improvements in outcomes over the nearly seven decades since the first cardiopulmonary bypass ( CPB ) procedure [ 2 ], appreciable interhospital variability persists in both the conduct of and outcomes associated with CPB [ 3 ]. Several efforts have emerged to advance the conduct and safety of CPB , including clinical registries , evidence-based guidelines [ 4 – 6 ] as well as professionally based standards and guidelines [ 7 – 9 ].
w Presented at the 60th AmSECT International Conference ; April 2022 , Phoenix , AZ . * Corresponding author : fitzgerd @ musc . edu
Despite the promulgation of these resources for practicing clinicians , little is known about contemporary CPB practices for adult cardiac surgery . While several large-scale clinical registries have emerged , publications to date often focus on a discrete area of practice ( e . g ., nadir hematocrit during CPB ) rather than broadly covering the conduct and practice of CPB . With several topic-specific ( e . g ., blood management ) guidelines have been published , evaluations of the implementation into practice have been infrequent [ 10 – 12 ]. Finally , while The American Society of ExtraCorporeal Technology ( AmSECT ) has developed professional standards and guidelines for adult CPB , few studies have evaluated real-world practice patterns . This survey aim to describe clinical perfusion practices across adult cardiac surgical programs located in a large , single , geographical region of the United States .
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