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

Wahba, Alexander; Milojevic, Milan; Boer, Christa; Somer, Filip De; Guðbjartsson, Tómas; Goor, Jenny van den; Jones, Timothy J.; Ломиворотов, В. В.; Merkle, Frank; Ranucci, Marco; Kunst, Gudrun; Puis, Luc

doi:10.1093/ejcts/ezz267

Cited by 100 publications

(133 citation statements)

References 325 publications

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“…On the other hand, lactate levels greater than 3 mmol at 6 hours after surgery increase the probability of major complications [14,43]. Therefore, these results suggest prove that in both group, lactate varied significantly depending on the condition/time at which the measurement was performed.…”

Section: Discussionmentioning

confidence: 64%

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

et al. 2020

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Introduction Hyperlactatemia occurs during or after extracorporeal circulation in the form of lactic acidosis, increasing the risk of postoperative complications and the mortality rate. The aim of this study was to evaluate whether continuous high-volume hemofiltration with volume replacement through a polyethersulfone filter during the extracorporeal circulation procedure decreases postoperative lactatemia and its consequences. Materials and methods This was a randomized controlled trial. Patients were randomly divided into two groups of 32: with or without continuous high-volume hemofiltration through a polyethersulfone membrane. Five patients were excluded from each group during the study period. The sociodemographic characteristics, filter effects, and blood lactate levels at different times during the procedure were evaluated. Secondary endpoints were studied, such as the reduction in the intubation time and time spent in ICU. Results Lactatemia measurements performed during the preoperative and intraoperative phases were not significantly different between the two groups. However, the blood lactate levels in the postoperative period and at 24 hours in the intensive care unit showed a significant reduction and a possible clinical benefit in the hemofiltered group. Following extracorporeal circulation, the mean lactate level was higher (difference: 0.77 mmol/L; CI 0.95: 0.01–1.53) in the nonhemofiltered group than in the hemofiltered group (p<0.05). This effect was greater at 24 hours (p = 0.019) in the nonhemofiltered group (difference: 1.06 mmol/L; CI 0.95: 0.18–1.93) than in the hemofiltered group. The reduction of lactatemia is associated with a reduction of inflammatory mediators and intubation time, with an improvement in liver function. Conclusions The use and control of continuous high-volume hemofiltration through a polyethersulfone membrane during heart-lung surgery could potencially prevent postoperative complications. The reduction of lactatemia implied a reduction in intubation time, a decrease in morbidity and mortality in the intensive care unit and a shorter hospital stay.

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Section: Discussionmentioning

confidence: 64%

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

et al. 2020

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“…[ 78 , 79 ] Even though the transmission risk is considered extremely low during cardiopulmonary bypass, the membrane oxygenator exhaust should be scavenged through a high efficiency particulate absorbing (HEPA) filter, and the oxygenator should be disposed of with the same precautions used for anesthetic ventilators. [ 79 , 80 ] To reduce the risk of aerosol transmission of viral particles on cardiopulmonary bypass, higher sweep rates and FiO2 levels have been proposed, together with other modifications of cardiopulmonary bypass such as a higher heparinization loading dose, higher active coagulation time, and more frequent cardioplegia administration, although the current evidence in this field remains scarce. [ 80 , 81 ] Furthermore, a cytokine filtration device such as CytoSorb® 300mL is used in some centers to reduce the inflammatory response syndrome caused by an active COVID-19 infection during cardiac surgery, and a large clinical trial in Germany is currently testing the efficiency of such filter in this fragile population.…”

Section: Perioperative Managementmentioning

confidence: 99%

Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic

Mihalj¹,

Mosbahi²,

Schmidli³

et al. 2021

Best Practice & Research Clinical Anaesthesiology

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“…The Australian and New Zealand College of Perfusionists has produced a statement on this matter 27. As per existing guidelines, it is recommended that oxygenators be scavenged similarly to anaesthetic ventilators 28…”

Section: Recommendationsmentioning

confidence: 99%

“…27 As per existing guidelines, it is recommended that oxygenators be scavenged similarly to anaesthetic ventilators. 28…”

Section: Cardiopulmonary Bypassmentioning

confidence: 99%

COVID ‐19 safety: aerosol‐generating procedures and cardiothoracic surgery and anaesthesia — Australian and New Zealand consensus statement

Irons

Pavey

Bennetts

et al. 2020

Medical Journal of Australia

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Introduction Coronavirus disease 2019 ( COVID ‐19) is a contagious disease that is caused by the severe acute respiratory syndrome coronavirus 2 ( SARS ‐CoV‐2). Health care workers are at risk of infection from aerosolisation of respiratory secretions, droplet and contact spread. There are a number of procedures that represent a high risk of aerosol generation during cardiothoracic surgery. It is important that adequate training, equipment and procedures are in place to reduce that risk. Recommendations We provide a number of key recommendations, which reduce the risk of aerosol generation during cardiothoracic surgery and help protect patients and staff. These include general measures such as patient risk stratification, appropriate use of personal protective equipment, consideration to delay surgery in positive patients, and careful attention to theatre planning and preparation. There are also recommended procedural interventions during airway management, transoesophageal echocardiography, cardiopulmonary bypass, chest drain management and specific cardiothoracic surgical procedures. Controversies exist regarding the management of low risk patients undergoing procedures at high risk of aerosol generation, and recommendations for these patients will change depending on the regional prevalence, risk of community transmission and the potential for asymptomatic patients attending for these procedures. Changes in management as a result of this statement This statement reflects changes in management based on expert opinion, national guidelines and available evidence. Our knowledge with regard to COVID ‐19 continues to evolve and with this, guidance may change and develop. Our colleagues are urged to follow national guidelines and institutional recommendations regarding best practices to protect their patients and themselves. Endorsed by Australian and New Zealand Society of Cardiac and Thoracic Surgeons and the Anaesthetic Continuing Education Cardiac Thoracic Vascular and Perfusion Special Interest Group.

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

Cited by 100 publications

References 325 publications

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic

COVID ‐19 safety: aerosol‐generating procedures and cardiothoracic surgery and anaesthesia — Australian and New Zealand consensus statement

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