B . Lohbusch et al .: J Extra Corpor Technol 2023 , 55 , 3 – 22 5
Figure 1 . Number and percentage ranges of CPB procedures reported in 2020 ( n = 58 ).
ECMO
utilization and support
Of the 58 centers , 54 ( 93.1 %) offer ECMO at their institution and 59.2 % ( 32 / 54 ) had a perfusionist as the ECMO Coordinator . Of those , 39.7 % performed 10 ECMO procedures or less ( Figure 6 ). Most centers ( 87.9 %) indicated that the perfusion team was responsible for ECMO initiation and discontinuation , with 91.4 % assigned to troubleshooting ( Table 6 ).
Techniques
Figure
2 . CPB-standby procedures (%) in 2020 ( n = 58 ).
( n = 24 , 41.4 %), electronic occlusion clamps ( n = 27 , 46.6 %), low arterial pump speed alarms ( n = 29 , 50 %), and venous reservoir pressure monitoring ( n = 32 , 55.2 %). The use of biocompatible coating on all circuitry except cannulas was reported in 47 ( 81 %) responses . Among those using biocompatible circuitry , only 2 ( 3.8 %) were tip-to-tip biocompatible and 3 ( 5.2 %) use bio-coating on limited circuit components .
The sites for temperature monitoring on patients are listed in Table 4 . The most frequently reported core temperature used was a bladder catheter ( n = 54 , 93 %). The least reported temperature sources were peripheral temperatures , both skin and tympanic , with an incidence of 1.7 % ( n = 1 ) and 6.9 % ( n = 4 ), respectively .
The use of short- and long-term mechanical circulatory support ( MCS ) devices are reported in Table 5 . Respondents were asked to select the devices offered at their centers . Short-term device usage included peripheral access pumps such as the intra-aortic balloon pump ( IABP ) ( 100 %, n = 58 ), ECMO ( 93.1 %, n = 54 ), and Abiomed Impella ( Abiomed , Danvers , MA , USA ) ( 87.9 %, n = 51 ). Long-term implantable devices included the Heartmate II and Heartmate III pumps ( Abbott Cardiovascular , Plymouth , MN , USA ), with a reported usage of 29.3 % ( n = 17 ) and 39.7 % ( n = 23 ), respectively .
Arterial blood gas analysis was performed via point-of-care ( POC ) handheld device in 51.7 % ( n = 30 ) of centers . The use of inline blood gas monitoring was reported in 48.3 % ( n = 28 ). Oxygen delivery ( DO2 ) monitoring during CPB was reported in 46.6 % ( n = 27 ), with 17 ( 29.3 %) using automated , real-time DO2 monitoring technology and 10 centers ( 17.2 %) performing manual calculations .
During mild to moderate hypothermia cases , 87.9 % ( n = 51 ) of centers employ alpha-stat for acid-base management , 10.3 % ( n = 6 ) use pH-stat , and 1.7 % ( n = 1 ) use a combination of both . In procedures requiring deep to profound hypothermia , 56.9 % ( n = 33 ) use alpha-stat , 22.4 % ( n = 13 ) use pH-stat , and 20.7 % ( n = 12 ) use a combination of both .
Plasmalyte-A was the most used priming solution ( Table 8 ). The most common priming additives were heparin , mannitol , and sodium bicarbonate ( Table 8 ). Other additives reported include dexamethasone , solumedrol , MgSO 4 , or no additives at all ( Table 8 ). del Nido was the most frequently used cardioplegia substrate ( 62.1 %, n = 36 ), followed by whole blood / microplegia ( 31 %, n = 18 ), and Buckberg cardioplegia ( 25.9 %, n = 15 ) ( Figures 7 and 8 ). The type of cardioplegia used varied according to the surgical procedure . Fewer centers used del Nido on isolated CABG procedures ( 48.3 %, n = 28 ). For these procedures , more centers used either 4:1 ( 46.6 %, n = 27 ) or whole blood / microplegia ( 24.1 %, n = 12 ) blood-based solutions . For non-CABG procedures 58.6 % ( n = 34 ) used del Nido , 41.4 % ( n = 24 ) used 4:1 , and 24.1 % ( n = 14 ) used microplegia ( Figures 7 and 8 ).