Current paediatric perfusion practice in North America

Hill, Aaron; Groom, Robert C.; Akl, Bechara F.; Lefrak, Edward A.; Kurusz, Mark

doi:10.1177/026765919300800104

Cited by 19 publications

(7 citation statements)

References 27 publications

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“…5 However, since the North American survey by Kurusz et al, 6 there have been no other formal surveys of perfusion safety, and authors have confined themselves to examining current trends in perfusion practice. [7][8][9][10] Despite continual advancement in technology and education over the decades since cardiopulmonary bypass (CPB) was introduced, the safety of patients undergoing CPB is still an issue requiring careful monitoring. Recent reports indicate that significant problems are still occurring, for example, complete electrical failure during CPB 11 or air embolus.…”

Section: Introductionmentioning

confidence: 99%

Australasian perfusion incident survey

1997

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An anonymous postal survey about perfusion accidents, incidents and safety procedures was conducted retrospectively in all identifiable cardiac surgery units in Australia and New Zealand over an 18-month period from January 1994 to July 1995. Responses were received from 69% of all eligible perfusionists representing 39 to 42 operating units. The most frequent incidents reported were heater/cooler failure (43% of respondents), urgent return to bypass following circuit disposal (38%), air embolus in a circuit not reaching the patient (24%), accidental cannula displacement (28%), protamine-induced circuit clotting postbypass (20%), hospital power failure (31%) and oxygenator membrane leaks (24%). There were 11 serious injuries and 10 deaths reported, giving an overall rate of serious injury or death of one in 1300 cases. However, the perfusion-related injury rate was lower, at one injury or death per 2500 perfusions. The use of safety equipment was widespread with low-level alarms in use by all respondents, bubble detectors by 74%, arterial line filters by 82% and written or computerized checklists by 80%. While the rate of injury was lower than that reported in surveys done elsewhere, the rate of reporting of incidents was greater and this may reflect a changing attitude of perfusionists to accountability in the delivery of their services. The data suggest that the level of safety in perfusion in Australasia is high but that improved incident reporting may help to further improve practices.

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Section: Introductionmentioning

confidence: 99%

Australasian perfusion incident survey

1997

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“…Retrograde autologous priming was also not standard, probably because perfusionists want to avoid the complexity it involves at the start of the CPB. Since the Boston hematocrit trials suggested the potential advantage of a higher hematocrit level during hypothermic CPB [19][20][21] , the trend in Japan has been to maintain hematocrit levels at over 25% during hypothermic CPB, especially during complex congenital heart surgery. Thus, most pediatric perfusionists avoid the non-transfusion CPB technique and vacuum-assisted venous drainage and retrograde autologous priming are not necessary for non-transfusion CPB techniques for young children.…”

Section: Discussionmentioning

confidence: 99%

Pediatric perfusion in Japan: 2010 practice survey

Itoh

Sano

Pouard³

2011

Perfusion

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We report here Japan's first pediatric perfusion survey. It covers practices from January 2007 through December 2009. Of the 70 congenital heart centers contacted, 53 (76%) completed the survey. They reported performing 3,379 pediatric cardiopulmonary bypass (CPB) procedures in 2009, 3,408 in 2008, and 3,358 in 2007.Twenty-eight percent of all centers used CPB circuits with a priming volume between 151-200 ml. All centers used pre-bypass ultrafiltration and only 6% used retrograde autologous priming. A biomaterial-coated circuit was used by 78% of the centers, a roller pump as the arterial pump by 91%, vacuum-assisted venous drainage by 39%, dilutional ultrafiltration by 48%, and modified ultrafiltration at the end of the procedure by 30%. A regional oxygen saturation monitor was used by 69% of the centers and high flow (150-200 ml/kg/min) management with alpha-stat blood gas control was standard during moderate to normothermic CPBs. Crystalloid cardioplegia solution was used as myocardial protection by 56% of the centers, electronic recording of monitoring data by 51%. The centers performed 98 pediatric extracorporeal membrane oxygenation procedures in 2007, 109 in 2008, and 119 in 2009; 58% of the centers used a centrifugal pump. This survey provides a description of the current practice in Japan. Future surveys will identify trends and rate of change in practice.

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“…In the last several years, many retrospective surveys have been published [8][9][10][11][12][13][14] that have further defined perfusion practice and experience. Other surveys have focused on pediatric perfusion, [15][16][17][18] extracorporeal membrane oxygenation (ECMO), [19][20][21][22][23] or blood conservation during CPB. 24 Two authors have attempted to assimilate and compare perfusion survey data and indicate trends in practice.…”

Section: What Do We Know About Perfusion Safety?mentioning

confidence: 99%

Perfusion safety: new initiatives and enduring principles

Kurusz¹

2011

Perfusion

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Perfusion safety has been studied and discussed extensively for decades. Many initiatives occurred through efforts of professional organizations to achieve recognition, establish accreditation and certification, promote consensus practice guidelines, and develop peer-reviewed journals as sources for dissemination of clinical information. Newer initiatives have their basis in other disciplines and include systems approach, Quality Assurance/Quality Improvement processes, error recognition, evidence-based methodologies, registries, equipment automation, simulation, and the Internet. Use of previously established resources such as written protocols, checklists, safety devices, and enhanced communication skills has persisted to the present in promoting perfusion safety and has reduced current complication rates to negligible levels.

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Current paediatric perfusion practice in North America

Cited by 19 publications

References 27 publications

Australasian perfusion incident survey

Australasian perfusion incident survey

Pediatric perfusion in Japan: 2010 practice survey

Perfusion safety: new initiatives and enduring principles

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