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62 D . C . Fitzgerald et al .: J Extra Corpor Technol 2024 , 56 , 55 – 64

Table 5 . Patient safety .

Continuous variables are expressed as median , [ IQR ], and categorical variables as count (%).

documented a median ( IQR ) indexed net prime volume of 378 mL / m 2 for cases performed between July 2011 through December 2016 [ 22 ]. Despite evidence supporting their use [ 20 ], ANH ( Level A evidence , rate : 25.4 %) and viscoelastic testing ( Level B – R evidence , rate : 22.8 %) were not employed among the majority of procedures in the PERForm registry . Opportunities to enhance their use may be realized by leveraging local multidisciplinary workgroups , as ANH requires close collaboration between anesthesia and perfusion personnel to safely perform the sequestration process . While viscoelastic sampling may not be performed at the point of care among the majority of procedures within the present sample , interpreting the results , and guiding therapeutic decisions must be a coordinated approach between surgical team members [ 23 ].

Over the more than seven decades since the initial use of CPB by Dr . John Gibbon , Jr ., there continue to be significant opportunities to advance the care and outcomes of patients undergoing cardiac surgery . Several initiatives have been undertaken by professional societies to address gaps in observed versus idealized outcomes , including but not limited to the creation and dissemination of evidence-based guidelines [ 20 , 24 – 27 ] and professional consensus-based standards and guidelines [ 28 ]. Nonetheless , prior studies have identified significant gaps in translating evidence-based guidelines into practice [ 29 ]. For instance , a large international survey was conducted of cardiac surgical team members to evaluate the uptake of the 2007 STS blood management guidelines [ 29 ]. The 1402 returned surveys ( 32 % response rate ) represented 677 U . S . and 34 Canadian institutions . While the majority of perfusionists ( 67 %) and anesthesiologists ( 78 %) reported having read some and / or all the guidelines , institutional discussions were noted to have occurred by only 20 % of respondents , with only 14 % of respondents reporting the development of an institutional monitoring group . Some investigators have also leveraged registries to track the penetration of published evidence-based guidelines into practice efficiently [ 30 ], with derivative quality improvement initiatives used to address observed gaps in practice [ 31 ]. Lohbusch and colleagues recently reported findings from the analysis of a survey distributed to the chiefs of perfusion at 167 adult cardiac surgical programs located within AmSECT ’ s Zone IV covering 16 Atlantic states [ 15 ]. While receiving a 34.7 % response rate , the investigators noted largescale variability in the use of practices within AmSECT ’ s

Standards and Guidelines . To our knowledge , this report is among the largest studies to leverage registry data to track trends in the dissemination of evidence-based guidelines , and the first registry-based study evaluating professionally based standards and guidelines .

The assessment of adverse CPB-related events traditionally has been undertaken through surveys [ 18 , 19 ] and voluntary incident reporting systems [ 17 , 32 , 33 ]. Established in 1998 , the Australia and New Zealand College of Perfusionists ’ Perfusion Incident Reporting System ( PIRS ) is an incident reporting system within and outside of Oceania [ 17 , 32 ]. More recently , Colligan and colleagues described the development and early findings derived from a North American incident and near-miss registry [ 33 ]. Designed as a federally designated Patient Safety Organization ( PSO ), the ORRUM PSO has recently partnered with AmSECT to provide professionally based patient safety work products . In both PIRS and ORRUM PSO , submitted reports are analyzed to derive key lessons learned . Uniquely , the present report documents events that are linked to clinically submitted registry data to derive rates for benchmarking and local quality improvement . Participants of the PERForm registry have access to online query tools to support further inquiry into submitted events and receive quarterly reports to facilitate benchmarking .

Institutional quality improvement ( QI ) programs aim to advance the safety and effectiveness of patient care by applying a systems approach for testing and implementing changes in day-to-day clinical practice [ 5 , 34 ]. Unfortunately , such programs are often challenged by a lack of robust data collection and monitoring systems . Participation in multicenter clinical registries , including the PERForm and STS-ACSD , may facilitate both the assessment and improvement of care especially when grounded in a robust collaborative learning environment . A collaboration between the MSTCVS-QC and the Michigan Perfusion Society has resulted in several successful evidencebased , statewide perfusion-specific QI initiatives [ 22 , 34 ]. A collaborative learning environment , whose foundation includes validated data and unblinded hospital-level performance within the confines of quarterly collaborative meetings , has been instrumental to the success of this partnership . Further dissemination and expansion ( e . g ., including anesthesiologists ) of this collaborative learning model is warranted to advance the interdisciplinary nature of CPB practices .