B . Lohbusch et al .: J Extra Corpor Technol 2023 , 55 , 3 – 22 9
Figure 8 . Cardioplegia formulas used for CABG and non-CABG procedures .
Table 9 . Autologous prime usage .
Autologous prime is used |
Percent of centers |
Never |
12.1 |
1 – 25 % of the time |
13.8 |
26 – 50 % of the time |
5.2 |
51 – 75 % of the time |
12.1 |
76 – 100 % of the time |
56.9 |
Table 10 . ANH usage .
Percent of procedures that use ANH |
Percent of centers |
Never |
43.1 |
1 – 25 |
29.3 |
26 – 50 |
5.2 |
51 – 75 |
10.3 |
76 – 100 |
12.1 |
conducted outside of the country may not reflect contemporary US perfusion practice [ 13 , 14 ]. North American-centric comprehensive surveys date back nearly 27 years [ 15 ]. Regional , multi-institutional clinical registries have previously described similar variations in CPB equipment and clinical management strategies ; however , the generalizability of these findings is restricted by the number of participating programs [ 16 , 17 ]. Validated survey tools may broaden the scope of program recruitment and improve our understanding of current perfusion practice . Further , a longitudinal survey design can not only assess clinical trends and guideline adoption , but also identify where the gaps exist for continued consensus development .
The results highlight areas of contrast between published evidence-based guidelines and real-world clinical practice . In 2007 , a collaboration between the Society of Thoracic Surgeons ( STS ) and the Society of Cardiovascular Anesthesiologists ( SCA ) resulted in a seminal publication of 57 perioperative clinical practice guidelines in cardiac surgical blood conservation and management [ 18 ]. Since then , updates to the guidelines were published in 2011 and 2021 [ 6 , 19 ]. Although several perfusion and intraoperative interventions were assigned high-level recommendations ( ACC / AHA Class I and IIa ), our
Table 11 . Anticoagulation and hemostasis management .
Number (%) |
Minimum ACT For CPB ( s ) |
350 |
4 ( 6.9 ) |
400 |
37 ( 63.8 ) |
450 |
4 ( 6.9 ) |
480 |
10 ( 17.2 ) |
Other |
2 ( 3.4 ) |
Target ACT for CPB ( s ) 350 |
1 |
( 1.7 ) |
400 |
11 ( 19 ) |
450 |
6 ( 10.3 ) |
480 |
36 ( 62.1 ) |
500 |
1 ( 1.7 ) |
Other |
2 ( 3.4 ) |
Anticoagulation Monitoring |
ACT only |
46 ( 79.3 ) |
ACT / HMS |
11 ( 19 ) |
HMS only |
1 ( 1.7 ) |
Perioperative Viscoelastic testing |
Yes |
20 ( 34.5 ) |
No |
38 ( 65.5 ) |
Protamine Dosing |
Fixed Dosing |
14 ( 24.1 ) |
HPT Titration |
16 ( 27.6 ) |
Ratio of heparin given |
27 ( 46.6 ) |
Other |
1 ( 1.7 ) |
CPB Cardiotomy suction termination |
Start of Protamine |
24 ( 41.4 ) |
1 – 25 % of protamine |
18 ( 31 ) |
26 – 50 % |
16 ( 27.6 ) |
Abbreviations : ACT = activated clotting time ; CPB = cardiopulmonary bypass ; HMS = Hemostasis Management System ; HPT = heparin protamine titration .
findings suggest the application of these techniques have not yet achieved widespread adoption . Examples include the use of autologous circuit priming and perioperative viscoelastic testing . Only 34.5 % of respondents reported using perioperative viscoelastic testing , and 69 % of centers indicated autologous