2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery: a tool to better clinical practice

Baker, Robert A.; Nikolić, Aleksandar; Alston, R. Peter

doi:10.1093/ejcts/ezz358

Cited by 19 publications

(9 citation statements)

References 5 publications

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“…However, the widest range of factors provoking the development of postoperative cognitive disorders is cardiopulmonary bypass [42]. This is the contact of the patient's blood with the surface of the circuit of the heart-lung machine, initiating SIR [43], hemolysis due to mechanical injury of erythrocytes from the operation of roller pumps, and contact of blood with the air [44], hemodilution, which causes a decrease in the patient's hematocrit and oncotic blood pressure [26,45]. The consequence of hemodilution and hemolysis, and not only large blood loss, explains such a frequent need for transfusion during cardiac surgery.…”

Section: Source Of Problemsmentioning

confidence: 99%

Delirium in Children after Cardiac Surgery: Brain Resuscitation

Grigoriev¹,

Ивкин²

2022

ICU Management and Protocols

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This chapter presents the current data on delirium in children in the postoperative period with the correction of congenital heart defects. The analysis of the causes of delirium, according to the literature data, pathophysiology, clinical signs, and methods of diagnosis of postoperative delirium, is shown. In addition, methods for the prevention of delirium in children during cardiac surgery are presented.

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Section: Source Of Problemsmentioning

confidence: 99%

Delirium in Children after Cardiac Surgery: Brain Resuscitation

Grigoriev¹,

Ивкин²

2022

ICU Management and Protocols

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“…While several large-scale clinical registries have emerged, publications to date often focus on a discrete area of practice (e.g., nadir hematocrit during CPB) rather than broadly covering the conduct and practice of CPB. With several topic-specific (e.g., blood management) guidelines have been published, evaluations of the implementation into practice have been infrequent (10)(11)(12). Finally, while The American Society of ExtraCorporeal Technology (AmSECT) has developed professional standards and guidelines for adult CPB, few studies have evaluated real-world practice patterns.…”

Section: Introductionmentioning

confidence: 99%

Adult Clinical Perfusion Practice Survey: 2020 results

Lohbusch

Olson

Magowan

et al. 2023

J Extra Corpor Technol

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Cardiovascular perfusion is a dynamic healthcare profession where new practices are frequently introduced. Despite the emergence of evidence-based clinical practice guidelines, little is known about their dissemination at the institutional level. Clinical practice surveys have been used to identify current trends in perfusion practice in the areas of equipment, techniques, and staffing. The aim of this survey is to describe clinical perfusion practices across adult cardiac surgical programs located in a large, single, geographical region of the United States. Following Institutional Review Board (IRB) approval, an 81-question survey was distributed to 167 adult perfusion programs across the Zone IV region of the American Society of Extracorporeal Technology (AmSECT), a non-profit professional society representing the extracorporeal technology community. Surveys were distributed to chief perfusionists through the Research Electronic Data Capture (REDCap) web-based survey response system. Responses were received from 58 of 167 centers across (34.7% response rate). Centrifugal pumps were used at 81% (n=47) of centers and 96.6% (n=56) use an open venous system or hard-shell venous reservoir. Del Nido was the most frequently used cardioplegia strategy with 62.1% (n=36) of centers reporting its use. Use of electronic medical records was reported in 43% (n=25) of centers, while 84.5% (n=49) report using Cardiopulmonary Bypass (CPB) protocols (>75% of all CPB activities). Extracorporeal Membrane Oxygenation (ECMO) support was reported in 93.1% (n=54) of programs, with 59.2% of programs (n=34) employing a perfusionist as ECMO Coordinator. The n+1 staffing model was reported by 50% (n=29), with 24% supporting the n+1 staffing for after hours and on-call procedures. Clinical practice surveys can be effective tools to inform clinicians on contemporary perfusion practice and identify deviations from professional standards and guidelines. Subsequent surveys may describe trends over time, assess standardization of practice, measure adherence to evidence-based guidelines, and foster improved patient care and outcomes.

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“…На такую роль может претендовать ограничение использования компонентов донорской крови в интраи послеоперационном периоде. Для пациентов детского возраста вопрос трансфузии стоит особенно остро, так как ее применение в кардиохирургии зачастую носит превентивный характер, позволяя избежать излишней гемодиллюции [17] из-за несо ответствия объема циркулирую щей крови ребенка и объема первичного заполнения аппарата ИК. При этом компоненты донорской крови, по данным исследований, сами по себе являются источником СВО [18].…”

Section: Introductionunclassified

Intraoperative transfusion is a risk factor for cerebral injury after cardiac surgery in children: a prospective observational study

Ивкин

Grigoryev

Balakhnin

et al. 2023

Annals of Critical Care

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INTRODUCTION: Donor blood components are able to initiate a systemic inflammatory response syndrome (SIRS) and potentiate neuroinflammation with subsequent cerebral damage. OBJECTIVE: To study the effect of transfusion on the development of cerebral damage during the surgical correction of congenital heart defects in children. MATERIALS AND METHODS: 78 patients aged from 1 to 78 months, weighing from 3.3 to 21.5 kg, were studied. All patients underwent correction of a septal defect under cardiopulmonary bypass. All patients were divided to group 1 — without the use of transfusion and group 2 — with the use of red blood cell transfusion. Cerebral damage markers (S-100-β protein, neuron-specific enolase (NSE) and glial fibrillar acidic protein (GFAP)) and SIRS (interleukins 1 (ILb-1), 6 (IL-6), 10 (IL-10) and tumor necrosis factor alpha (TNF-α) were studied. Markers ware studied at three control points: 1 — before the start of surgery, 2 — immediately after end of cardiopulmonary bypass, 3 — 16 hours after the end of the operation. RESULTS: The peak concentration of most markers in the blood in both groups of patients was noted at the 2nd control point. The concentration of all markers of cerebral damage was significantly higher in the transfusion group at the 2nd control point: S-100-β protein (ng/ml) — 509.90 [379.30–871.70] and 717.10 [517.90–1195.33] (р = 0.024); NSE (ng/ml) — 17.55 [11.19–26.41] and 34.05 [17.06–44.90] (р = 0,023); GFAP (ng/ml) — 0.1190 [0.1135–0.1245] and 0.1231 [0.1138–0.1493]. Correlations were found between markers of cerebral damage and SIRS, the strongest of which was the relationship between NSE and TNF-α at the 3rd control point — Rho = 0.43 (p = 0.0001). A correlation of S-100-β protein with transfusion volume was observed at the 2nd (Rho = 0.48, p = 0.00065) and 3rd control points (Rho = 0.36, p = 0.01330). CONCLUSIONS: The influence of the fact of transfusion and the dose of red blood cell on the development of cerebral damage during cardiac surgery in children has been proven.

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2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery: a tool to better clinical practice

Cited by 19 publications

References 5 publications

Delirium in Children after Cardiac Surgery: Brain Resuscitation

Delirium in Children after Cardiac Surgery: Brain Resuscitation

Adult Clinical Perfusion Practice Survey: 2020 results

Intraoperative transfusion is a risk factor for cerebral injury after cardiac surgery in children: a prospective observational study

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