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A NATION-WIDE SURVEY OF CURRENT CLINICAL PRACTICES IN MANAGEMENT OF CARDIOPULMONARY BYPASS IN PATIENTS UNDERGOING CARDIAC SURGERY

University Health Network, Toronto General Hospital

INTRODUCTION

At present, there are no accepted guidelines in North America for management of cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery. Current evidence may modify strategies for transfusion triggers, measures of sufficient anticoagulation, re-warming, use of shed blood, use of antifibrinolytic agents, maintenance of perfusion pressure whilst on CPB, and utilization of transesophageal and epiaortic echocardiography. We conducted a nation wide survey to determine current practices of CPB management in low and high risk of patients undergoing cardiac surgery.

METHOD

A postal survey was sent to all cardiac centers in Canada. The survey took a form of two case scenarios to which respondents were asked to complete a questionnaire detailing their current clinical practice. The questionnaire included details of CPB prime, type of oxygenators, perfusion pressure, use of shed blood, transfusion triggers, temperature management, use of antifibrinolytics, glucose management, and utilization of echocardiography. Identical questionnaires were sent to both Anesthesia and Perfusion departments.

Case 1. A 75 year old male with unstable angina, NIDDM, and left ventricular ejection fraction of 40% is scheduled for triple bypass surgery.

Case 2. A 75 year old female with a history of stroke and recurrence of angina who has had a previous CABG is scheduled for a redo CABG.

RESULTS

A survey was mailed to 34 cardiac centers. We received 15 (44%) replies from anesthesia and 22 (64%) from perfusion departments. There was considerable difference between anesthesia and perfusion response with respect to management of perfusion pressure, hematocrit and re-warming strategies whilst on CPB.

(Table and Figure)

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DISCUSSION

The survey determined that there is wide range of standards applied to low and high risk of patients undergoing CABG surgery. There was a significant discrepancy between anesthesia and perfusion responses with respect to management strategies for these patients. Evidence based approach should be encouraged for optimal management of CPB during CABG surgery.

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