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

Abstract

The development of standards and guidelines by professional societies offers clinicians guidance toward providing evidence-based care. The ultimate goals of standards and guidelines are to standardize care and improve patient safety and outcomes while also minimizing risk. The American Society of ExtraCorporeal Technology (AmSECT) currently offers perfusionists several clinical resources, primarily the Standards and Guidelines for Perfusion Practice; however, no document exists specific to pediatric perfusion. Historically, the development of a pediatric-specific document has been limited by available scientific evidence due to smaller patient populations, sample sizes, and variable techniques among congenital perfusionists. In the current setting of evolving clinical practices and increasingly complex cardiac operations, a subcommittee of pediatric perfusionists developed the Standards and Guidelines for Pediatric and Congenital Perfusion Practice. The development process included a comprehensive literature review for supporting evidence to justify new recommendations or updates to the existing AmSECT Adult Standards and Guidelines document. Multiple revisions incorporating feedback from the community led to a finalized document accepted by the AmSECT membership and made available electronically in May 2019. The Standards and Guidelines for Pediatric and Congenital Perfusion Practice is an essential tool for pediatric perfusionists and serves as the backbone for institutionally based protocols, promotes improved decision-making, and identifies opportunities for future research and collaboration with other disciplines. The purpose of this manuscript is to summarize the process of development, the content, and recommended utilization of AmSECT’s Standards and Guidelines for Pediatric and Congenital Perfusion Practice.

Recommendations for Centers Performing Pediatric Heart Surgery in the United States

“…The N + 1 staffing model specifies N equals the number of operating rooms in use at any given time at a single site. 86,87 For example, in the event of two active procedures requiring cardiopulmonary bypass, it is recommended that there are three b N + 1 staffing model further described in the text. Briefly, as perfusionists are the only allied health care providers formally educated in the provision of extracorporeal cardiopulmonary support, it is recommended a perfusionist should always be immediately available to back up the primary perfusionist on each procedure requiring cardiopulmonary bypass.…”

“…It is recommended that procedures which have been identified by institutional process or protocol to be at elevated risk of requiring cardiopulmonary bypass should have a protocol for transition to bypass. 86,87 Each of these cases should have at least one perfusionist assigned for coverage and an appropriate circuit readily available. Response times for perfusion team members on call may vary due to geographical and institutional nuances.…”

“…Standards and Guidelines for Pediatric and Congenital Perfusion have previously been published by the American Society of Extracorporeal Technology (AmSECT) and endorsed by the CHSS and CCAS. 86,87 The AmSECT document defines “standards” as practices, technology, and/or conduct of care that institutions shall meet in order to fulfill the minimum requirements for conducting cardiopulmonary bypass, and a “guideline” as a recommendation that should be considered and may assist in the development and implementation of protocols. 86,87 In the present document, we recommend the AmSECT standards should be uniformly applied across both Comprehensive and Essential Care Centers.…”

“…86,87 The AmSECT document defines “standards” as practices, technology, and/or conduct of care that institutions shall meet in order to fulfill the minimum requirements for conducting cardiopulmonary bypass, and a “guideline” as a recommendation that should be considered and may assist in the development and implementation of protocols. 86,87 In the present document, we recommend the AmSECT standards should be uniformly applied across both Comprehensive and Essential Care Centers. A summary of key portions of the AmSECT standards is included below and in Table 9.…”

Verbesserte Qualität gelagerter Erythrozytenkonzentrate durch maschinelle Autotransfusion

“…Osthaus et al zeigten, dass bei einem pädiatrischen Herz-Lungen-Maschinen-Einsatz die Verwendung einer physiologischen Restitutionslösung in Form einer HCO3 --gepufferten Hämofiltrationslösung Störungen des Elektrolyt-und Säure-Base-Haushalts verringern kann [30]. In den "Guidelines for Pediatric and Congenital Perfusion Practice" der American Society of Extracorporeal Technology wird empfohlen, bei Verwendung von EK zum Priming entweder eine Ultrafiltration durchzuführen oder gewaschene EK zu verwenden [31].…”