The Journal of ExtraCorporeal Technology Issue 55-1 | Page 16

8 B . Lohbusch et al .: J Extra Corpor Technol 2023 , 55 , 3 – 22
Table 6 . Perfusion team ’ s clinical responsibilities with ECMO .
ECMO Responsibility
Percent of Centers
Initiation and Discontinuation
87.9
Troubleshooting
91.4
Direct bedside staffing support
58.6
Rounding model ( in house but not bedside )
36.2
Intra-hospital transport
75.9
External transport
69.0
Table 7 . CPB techniques ( n = 58 ).
Number , (%)
Pulsatile perfusion
None
54 ( 93.1 )
During Aortic Cross Clamp Period
3
( 5.2 )
During Entire CPB
1
( 1.7 )
VAVD usage
Always
24 ( 41.4 )
Select procedures
29 ( 50 )
Do not use
5
( 8.6 )
Carbon dioxide ( CO 2 ) gas priming of the circuit
Always
16 ( 27.6 )
Sometimes
4
( 6.9 )
Never
38 ( 65.5 )
Prescriptive oxygenation TM
18 ( 31 )
No
40 ( 69 )
Cerebral oximetry monitoring
Always
31 ( 53.4 )
Sometimes
22 ( 37.9 )
Never
5
( 8.6 )
Blood gas analysis / management
Point of care ABG device
30 ( 51.7 )
CPB inline blood gas monitoring
28 ( 48.3 )
Arterial and venous monitoring
18 ( 31 )
Oxygen delivery monitoring
None
31 ( 53.4 )
Manual ; calculate during CPB
10 ( 17.2 )
Automated DO2 capture
17 ( 29.3 )
Blood gas management strategy / mild hypothermia
Alpha-stat management
51 ( 87.9 )
pH stat management
6 ( 10.3 )
Pulsatile perfusion
None
54 ( 93.1 )
During aortic cross clamp period
3
( 5.2 )
During Entire CPB
1
( 1.7 )
VAVD usage
Always
24 ( 41.4 )
Select procedures
29 ( 50 )
Do not use
5
( 8.6 )
Carbon dioxide ( CO 2 ) gas priming of the circuit
Always
16 ( 27.6 )
Sometimes
4
( 6.9 )
Never
38 ( 65.5 )
Prescriptive oxygenation™
Yes
18 ( 31 )
Both
1
( 1.7 )
Blood gas management strategy / deep hypothermia
Alpha-stat management
33 ( 56.9 )
pH stat management
13 ( 22.4 )
Both
12 ( 20.7 )
Abbreviations : CPB = cardiopulmonary bypass .
Table 8 . CPB circuit prime constituents .
Number , (%)
Base Priming Solution
Plasmalyte-A
43 ( 74 )
Lactated Ringers
4 ( 7 )
Normosol-R
9 ( 16 )
Other
2 ( 3 )
Prime additives
Heparin
50 ( 86 )
Sodium Bicarbonate
34 ( 59 )
Albumin 5 %
5 ( 9 )
Albumin 25 %
22 ( 38 )
Mannitol
41 ( 71 )
Amicar / TXA
18 ( 31 )
Antibiotic
3 ( 5 )
Other
8 ( 14 )
Abbreviations : TXA = Tranexamic acid .
Figure
7 . Center-level cardioplegia usage ( n = 58 ).
1 – 25 % of protamine has been delivered , and 27.6 % ( n = 15 ) terminate suction when 26 – 50 % of protamine is administered . Protocol adoption and adherence
All centers reported using a checklist for some part of their practice ( Table 12 ). Most centers used a checklist for assembly / priming , and initiation of CPB . 65.5 % ( n = 38 ) of centers keep a dry assembled circuit for routine on-call coverage , and 34.5 % ( n = 20 ) keep a primed assembled circuit . Once a pump is primed , 4 programs ( 6.9 %) keep it for up to 48 hours , and 10 ( 17.2 %) will use it for up to 72 h . Six centers ( 10.3 %) will keep a primed circuit for up to 1 week . Most centers reported 76 – 100 % of their CPB clinical practice is guided by written departmental protocols ( Table 13 ).
Discussion
This survey provides an analysis of adult perfusion practice in the Northeast and Mid-Atlantic regions of the United States . We identified substantial variation in multiple areas of perfusion clinical techniques , equipment , staffing , and adoption of clinical practice guidelines . Due to the paucity of comprehensive surveys conducted across US adult clinical perfusion programs , few opportunities have existed to identify and report trends in operative equipment and techniques . The most recent surveys