The Journal of ExtraCorporeal Technology No 57-1 | Page 25

V . A . dos Reis Filho et al .: J Extra Corpor Technol 2025 , 57 , 18 – 23 19

use of an institution-approved checklist before and during CPB , in the perioperative period ( weaning from CPB , post-CPB , emergent reinstitution of CPB ), and in procedures performed by clinical perfusionists [ 10 ]. AmSECT also recommends that the perfusionist should employ a checklist for additional perfusion services such as autotransfusion , intra-aortic balloon pump , and extracorporeal membrane oxygenation ( ECMO ) [ 9 ].

Human failure and poor maintenance of devices can contribute to the occurrence of accidents . The surgical team interaction , the early diagnosis , and the prompt intervention have shown to be crucial for a favorable outcome . Therefore , the clinical perfusionist plays a crucial role in cardiopulmonary bypass procedures , and their involvement is of utmost importance [ 6 ]. The perfusionist needs to adhere strictly to established procedures to ensure patient safety throughout the entire duration of CPB [ 11 ].

The assembly of the extracorporeal circuit and the inspection for potential failures in the perfusion equipment before its clinical use are important . The technological progress is evident , like the incorporation of alarms and fail-safe devices , but care continues to be vital for conducting CPB . However , the perfusionist ’ s attention to detail and adherence to pre-bypass checklists are still the foundation for a safe practice . Human error is the leading cause of accidents , even more than mechanical failure . CPB equipment test needs to be carried out to ensure roller pumps and heater / coolers are functioning well . As for the centrifugal pump console , it must be checked to observe potential electrical power failure ; the most common method to do so is temporarily disconnecting the energy line from the console and checking if the backup battery alarm is fully operational . After the CPB circuit is assembled , the oxygenator and blood reservoir are placed in their proper support . The gas supply connection , the arterial flow pump tubes , and the roller lines should be safely connected ; after that , the rollers must be properly calibrated . The two water lines of the heat exchanger are connected to the oxygenator , then water starts to flow to ensure there is no leakage [ 11 , 12 ].

The checklist format is a process of continuous monitoring capable of developing efficient prevention actions , improving the cardiopulmonary bypass practice , and providing safer support to patients during a surgical procedure . The objective of the research was to develop and validate a checklist for cardiopulmonary bypass .

Methodology

A validation methodology based on expert consensus was applied in this study , using the Delphi technique to develop and evaluate the instrument . The Delphi method , a structured communication process , involves multiple rounds of questionnaires , allowing experts to revise their responses based on feedback until a consensus is reached . In this study , two rounds were conducted to develop the checklist . The research was conducted from March to May 2023 . The study was approved by the Research Ethics Committee of the Instituto Dante Pazzanese de Cardiologia ( IDPC ) – São Paulo , with the CAAE [ Certificate of Presentation for Ethical Appreciation ] number : 67490723.5.0000.5462 .

Table 1 . Preliminary list with 42 elements . The score over 90 % of acceptance would be kept on the list .

CPB – cardiopulmonary bypass ; ACT – activated coagulation time .

Five clinical perfusionists with specialization recognized by the Sociedade Brasileira de Circulação Extracorpórea