2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

Abstract

Special Article responsible in the event of any contradiction, discrepancy and/or ambiguity between the EACTS, EACTA and EBCP Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EACTS, EACTA and EBCP Guidelines fully into account when exercising their clinical judgement as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the EACTS, EACTA and EBCP Guidelines do not, in any way whatsoever, override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do the EACTS, EACTA and EBCP Guidelines exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. The article has been co-published with permission in the British Journal of Anaesthesia, the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery.

American Society of ExtraCorporeal Technology: Development of Standards and Guidelines for Pediatric and Congenital Perfusion Practice (2019)

“…1 Internationally, documents outlining standards and guidelines for perfusion practice exist as well. The following two documents have been recently published in Europe and Brazil, respectively: European Association for Cardio-Thoracic Surgery/European Association of Cardiothoracic Anesthesiology/European Board of Cardiovascular Perfusion guidelines on cardiopulmonary bypass in adult cardiac surgery 9 and the Brazilian Society for Cardiovascular Surgery/Brazilian Society for Extracorporeal Circulation Standards and Guidelines for Perfusion Practice. 10 In 2017, AmSECT leadership requested the development of a separate document specific to pediatric and congenital cardiopulmonary bypass (CPB), one that had not previously existed.…”

Diaphragm Paralysis After Cardiac Surgery: A Frequent Cause of Post-Operative Respiratory Failure

“…Individuals with DD had more arterial hypertension (64.3% vs. 52.6%; p<0.0001), higher body mass index (BMI) (28 [25][26][27][28][29][30] kg/m2 vs. 26 [24][25][26][27][28][29] kg/m2; p<0.0002) and higher incidence of coronary bypass grafting (58.8% vs. 46.6%; p=0.0001). DD was associated with more postoperative pneumonia (23.9% vs. 8.7%; p<0.0001), reintubation (8.8% vs. 2.9%; p<0.0001), tracheotomy (3.3% vs. 0.3%; p<0.0001), non-invasive ventilation (45.6% vs. 5.4%; p<0.0001), duration of mechanical ventilation (5 [4][5][6][7][8][9][10][11] h vs. 4 [3][4][5][6] h; p<0.0001), and ICU and hospital stays (14 [11][12][13][14][15][16][17] days vs. 13 [11][12][13][14][15][16] days; p<0.0001). In multivariate analysis, DD was associated with coronary artery bypass grafting (OR=1.9[1.5-2.6]; p=0.0001), arterial hypertension (OR=1.4[1.1-1.9]; p=0.008), and BMI (OR per point =1.04[1.01-1.07] kg/m2; p=0.003).…”

“…Past studies have identi ed several risk factors for postoperative DD, including age, diabetes, mammary artery harvesting, peri-operative cold solutions and extracorporeal circulation time [7,14,15]. However, actually, most cardiac interventions no longer use cold cardioplegia, [16] and coronary grafts are most often made using one or two mammary arteries [17,18]. DD is suspected when post-operative acute respiratory dysfunction occurs with paradoxical ventilation and ascent of the diaphragmatic dome on the chest X-ray.…”

Will high-dose heparin affect blood loss and inflammatory response in patients undergoing cardiopulmonary bypass?

“…While protamine primarily neutralizes heparin, it also possesses anticoagulant properties which are attributed to interaction with platelet function, interference with coagulation factors, and potentiating clot lysis. 16 Available evidence [16][17][18] suggests not exceeding a protamine to heparin ratio of 1:1 to reduce post-operative bleeding and transfusion requirements. Based on this ratio, protamine is administered such that 1 mg of protamine is administered per 100 U of heparin.…”