S. Pervaiz Butt et al.: J Extra Corpor Technol 2025, 57, 82 – 88 87
These issues may also potentially be translated across to other countries with low income. Although cardiac surgery may be well established in certain places, budgeting issues and a lack of funding into perfusion departments would definitely have a knock-on effect into the level of safety a perfusionist can provide. Without thorough resource allocations the best output will never be achieved.
Limitations
The survey has certain limitations that need to be acknowledged. The sample size, based on voluntary participation, may not fully represent the entire perfusion community, leading to potential selection bias. Additionally, the survey’ s reliance on yes-and-no choices may limit the depth of responses and overlook important nuances. Furthermore, using individual perfusionists as the unit of analysis, rather than hospitals, could be seen as a limitation since practice is often influenced by a center’ s protocols rather than individual preferences. The survey focused on five specific questions related to the use of safety devices in the circuit, which excluded broader aspects of standards, quality, and safety such as training, safety checklists, procedure-specific protocols, staffing, and duty hours. This narrow focus limits the scope of the insights obtained. To address these limitations, future research should consider more comprehensive sampling methods to ensure a representative sample of perfusion professionals. Incorporating open-ended questions and qualitative interviews can provide a deeper understanding of experiences and challenges. Moreover, exploring other safety features and monitoring specific outcomes in patients will provide a more holistic view. Future investigations should examine the specific factors contributing to any adverse outcomes in patients and the implications of different perfusion practices in diverse healthcare settings. By addressing these areas, future research can advance perfusion safety practices and enhance patient care in Pakistan.
Conclusion
The survey highlights the need for standardization of perfusion practices in Pakistan to ensure the safety and quality of CPB procedures. Efforts should be made to provide perfusionists with the necessary resources and training to adhere to international standards. Further studies and interventions are required to address the gaps identified in this survey.
Recommendations
1. Training and Education: Regular workshops and training sessions should be conducted to update perfusionists on the importance and use of monitoring equipment during CPB.
2. Resource Allocation: Hospitals and cardiac centers should ensure the availability of essential monitoring devices and disposables to all perfusion teams.
3. Policy Development: National guidelines should be developed to standardize perfusion practices across all cardiac centers in Pakistan.
4. Outcome measuring: Outcomes should be routinely measured to ensure the incorporation of safety devices are positively helping outcomes and to identify other areas of improvement.
Funding The authors received no funding to complete this research.
Conflicts of interest The authors declare no conflicts of nterest.
Data availability statement The research data are available on request from the authors.
Author contribution statement
Salman Pervaiz Butt: Lead Conceptualization, Lead Data curation, Lead Supervision, Lead Writing – original draft, Lead Writing – review & editing, and Project administration.
Nabeel Razzaq: Equal Data curation, Supporting Formal, Analysis,
Supporting review & editing, Supporting Visualization. Bill Cook: Supporting Formal Analysis, Review & editing. Babar Ali: Supporting Formal Analysis, Review & editing. Hashim Saqib: Supporting Formal Analysis, Review & editing. Aerfa Amir: Supporting Formal Analysis, Review & editing. Yazan Alijabery: Supporting review & editing. Salman Abdulaziz: Equal Methodology, Equal Project administration. Review & editing. Arshad Ghori: Supporting review & editing.
Ethics approval
This study does not involve human and / or animal subjects; therefore, ethical approval was not required.
References
1. Newland RF, Baker RA, Mazzone AL, et al. Should air bubble detectors be used to quantify microbubble activity during cardiopulmonary bypass? J Extracorp Technol. 2015; 47:147 – 179.
2. Kelting T, Searles B, Darling E. A survey on air bubble detector placement in the CPB circuit: a 2011 cross-sectional analysis of the practice of Certified Clinical Perfusionists. Perfusion. 2012; 27:345 – 351.
3. Puthettu M, Vandenberghe S, Bagnato P, et al. Gaseous microemboli in the cardiopulmonary bypass circuit: presentation of a systematic data collection protocol applied at Istituto Cardiocentro Ticino. Cureus. 2022; 14( 2): e22310.
4. Chung EM, Banahan C, Patel N, et al. Size distribution of air bubbles entering the brain during cardiac surgery. PLoS One. 2015; 10: e0122166.
5. Borger MA, Peniston CM, Weisel RD, et al. Neuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions. J Thorac Cardiovasc Surg. 2001; 121:743 – 749.
6. Wang S, Ündar A. Vacuum-assisted venous drainage and gaseous microemboli in cardiopulmonary bypass. J Extracorp Technol. 2008; 40:249 – 256.
7. Johagen D, Svenmarker S. The scientific evidence of arterial line filtration in cardiopulmonary bypass. Perfusion. 2016; 31( 6): 446 – 457.