22 V . A . dos Reis Filho et al .: J Extra Corpor Technol 2025 , 57 , 18 – 23
comprehensive data , and 2 ( Level Sensor ; Bubble Sensor ) items from the previous round under 90 % of approval were kept in the second list , considering that , even though they are not included in the reality of the professionals , they may represent a highly potential perspective in the future . After the analysis of the second round results , all 37 items reached a mean 4and SD 1 . 0 ( Table 2 ). Three items were additionally suggested for inclusion in the final checklist .
Based on the results obtained in the last round , a cardiopulmonary bypass checklist has been developed . This document covers all items and checks required , from identification of components to checking devices and operational tests . The items were divided into 10 topics and 3 elements were included in the last round after suggestion by the specialists : venous / arterial temperature sensor , pressure gauge , and cannulae ) ( Figure 1 ).
Discussion
The list we have developed encapsulates all the pre-bypass moments , from preparing the equipment to the initial procedure , showing aspects such as functional device tests , identification of circuit components , preparation of equipment , and observing potential CPB-related failures . The purpose of the checklist is to ensure the proper execution of essential steps and necessary verifications for the efficient functioning of the system . The guidelines published by the Brazilian Society for Cardiovascular Surgery and Brazilian Society for Extracorporeal Circulation [ 8 ] as well as the perfusion checklist developed by the American Society of Extracorporeal Technology [ 9 ] propose that the perfusionist use this checklist in all CPB procedures , and to include it in the patient ’ s medical chart . SBCEC and SBCCV recommend the use of a checklist throughout the perioperative period , which would involve not only the pre-bypass period but also the circulatory assistance period and post-bypass ; a document in which the perfusionist highlights all pieces of information related to this period has been already established and used , whichiscalledthe “ perfusion sheet ”. This article is specifically focused on preparing a checklist for the period prior to the extracorporeal procedure starting , and we consider that we have attained this goal .
Standardization is one of the main benefits of the CPB checklist in cardiovascular surgery . CPB involves a set of devices and interconnected stages , and detail is crucial for the system ’ s operation . The checklist provides a systematic and consistent guide , which aims at limiting the possibilities of errors that are often caused by not identifying issues earlier or even by the negligence of the professionals . Nicoletti [ 11 ] points out important elements to develop a checklist , with nine topics suggested being crucial : ( 1 ) Patient identification data , ( 2 ) equipment , ( 3 ) materials , ( 4 ) surgery planning , ( 5 ) circuit preparation , ( 6 ) prime , ( 7 ) anticoagulation , ( 8 ) macro monitoring and patient micro-hemodynamics ( 9 ) temperature . The items suggested by Nicoletti [ 11 ] contain elements focused on the period pre- and intra-surgical . AmSECT [ 12 ] recommends using the perfusion checklist developed by them with the topics : of weaning / termination ( VAVD off ) and post bypass ( announce bypass terminated ), or a reasonable equivalent .
Our study focuses on the pre-CPB phase and highlights ten essential topics designed to enhance patient safety through early detection of adverse events . By carefully checking each item on the checklist , we enable the prompt identification of any failures before the procedure begins . This proactive approach allows for swift and effective interventions , ensuring continuity in the process .
The technical complexity and interdependence of devices require a systemic approach , in which every step is consistently and precisely carried out . It is essential to integrate this practice into the professional ’ s routine , making it a habit process . The standardization after checking all elements in the cardiopulmonary bypass technique may reduce the variability between professionals . Future studies must analyze the ease of use , execution time , and team engagement with the developed checklist .
While checklists are crucial for ensuring safety and consistency in clinical perfusion practice , excessively long or redundant checklists can lead to disengagement and errors from routine memorization . Drawing parallels to the aviation industry , where checklist fatigue has been well-documented , we will suggest focusing on critical parameters directly related to patient safety and eliminating redundant steps . This selective approach ensures that the checklist remains an effective tool for error prevention without overwhelming the user .
A limitation of the study was the number of participating judges . Five perfusionists were included in the research from the same center / service , however , it would be important to expand the criteria used to compose the sample of experts . The involvement of professionals from more than one health service and the participation of some professionals who work in the surgical environment , such as cardiac surgeons and anesthesiologists , would also be interesting .
Conclusion
The use of specific cardiopulmonary bypass checklists comes into view as a highly proficient strategy , capable of promoting substantial improvements in the procedure safety and quality , being vital to ensure excellence in care for patients undergoing cardiovascular surgeries . The implementation and approval of this checklist should be considered as a practice recommended in cardiovascular surgery-aimed institutions and services , aiming at providing safer and more successful results .
Funding The authors received no funding to complete this research .
Conflicts of interest The authors declare no conflict of interest .
Data availability statement The research data are available on request from the authors .
Author contribution statement
Valdir Assis dos Reis Filho : Lead Conceptualization , Lead Data curation , Lead Supervision , Lead Formal analysis , Lead Validation , Lead Visualization , Lead Writing – original draft , Lead Writing – review & editing , Lead Methodology and Project administration .