Australian and New Zealand perfusion survey: management and procedure

Abstract

In this report, we will discuss management and procedural aspects of perfusion practice. This report allows us to compare and contrast recent trends and changes in perfusion with historic practices. A survey comprised of 233 single-answer and 12 open-ended questions was sent by e-mail to senior perfusionists or individuals in charge of perfusion in 40 hospital groups. The survey encompasses a review of the perfusion practices for the calendar year of 2003, and respondents were required to answer the survey based on the predominant practice in their institutions. Standard management of routine adult cardiopulmonary bypass (CPB) in 2003 consisted of perfusion strategies that achieved a target temperature of 32.0 degrees C (range, 28.0-35.0 degrees C), a flow index of 2.4 L/min/m2 (range, 1.6-3.0 L/min/m2) during normothermia and 1.8 L/min/m2 (range, 1.2-3.0 L/min/m2) during hypothermia, and a pressure during CPB between 50 (range, 30-65 mmHg) and 70 mmHg (range, 60-95 mmHg). Myocardial protection with blood cardioplegia was used in 77% of the 20,688 CPB cases, whereas in 53% cases, cardiotomy blood was never processed. Pre-operatively, 76% of perfusion groups assessed their patients (21% directly with the patient), and 85% responded that perfusionists performed or participated in a formal pre-bypass checklist. The majority of the perfusion groups used a handwritten perfusion record (62%), 12% used an electronic perfusion record, and 26% used both, whereas more than one half of the groups were involved in quality assurance (79%), incident reporting (74%), audits (62%), research (53%), participating in interdisciplinary meetings (53%), and morbidity and mortality meetings (65%). Only 26% conducted formal perfusion team meetings. This report outlines the status of clinical management and procedural performance for perfusion practices in Australia and New Zealand in 2003. Awareness of these trends will allow perfusionists to assess both individual practices and unit performance.

Figure 1.

Cardioplegia temperature. •, mean; Δ, mode; two-way bars, range.

Figure 2.

High-risk CPB protocols. Always, black; nearly always, diagonal; never, white; no response, outlined diamond; sometimes, speckled.

Figure 3.

Alternate extracorporeal support. ECMO, extracorporeal membrane oxygenation; Heart, heart transplant; ILP, isolated limb perfusion; Liver, liver transplant; L/VA, long-term ventricular assists; Lung, lung transplant; M/VA, medium-term ventricular assists; N, number of perfusion groups; S/VA, short-term ventricular assists. •, mean; Δ, mode; two-way bars, range.