Survey: Retrospective Survey of Monitoring/Safety Devices and Incidents of Cardiopulmonary Bypass for Cardiac Surgery in France

Abstract

Several surveys showed that cardiopulmonary bypass (CPB) is associated with incidents that negatively affect outcome and suggested that improved monitoring and safety could be associated with a decreased rate of incidents. In 2004, the French “Haute Autorité de Santé”(an independent French government advisory agency) and the French College of Perfusion issued recommendations concerning safety and monitoring devices for CPB. The aims of this study were to investigate the difference between the recommendations and the clinical practice of CPB shortly after publication of the recommendations and compare the 2005 situation with the results of a previous survey performed in France and to investigate the rate of perfusion incidents and their outcome. A 62-item questionnaire was sent in January 2006 to all 66 centers performing cardiac surgery and CPB in France. The survey investigated the use of safety and monitoring devices as well as perfusion incidents for 2005. Fifty-seven centers (response rate, 86%) returned the questionnaire, totaling 34,496 CPB procedures. There was a wide difference between the recommendations and the reported use of safety and monitoring devices with no clinically relevant change from the previous French survey concerning 2001. An incident was reported for every 198 CPB procedures with death at a frequency of 1:4864 and permanent sequelae of 1:11,349, respectively (a permanent injury or death in 1:3220 procedures). The three most frequent perfusion incidents were adverse effects to protamine (1:1702), dissection at the arterial cannulation site (1:1792), and coagulation of the circuit (1:4864). In conclusion, this survey showed that an important effort must be made in France to implement into clinical practice the recommendations concerning CPB monitoring and safety devices. The analysis of CPB-related incidents suggest that, with the exception of protamine adverse effects, the majority of deaths and severe permanent injuries in this survey could probably be avoided by improved use of the monitoring and safety devices.

Simulated cardiopulmonary bypass: a high fidelity model for developing and accessing clinical perfusion skills

“…Incorporating this model into the national curriculum may accelerate the trainees' development of a transferable skill in an environment that is student-focused and without introducing avoidable learning curve risks into the care of real patients [ 20 , 21 ]. This model could be used in a pre-clinical skill development curriculum which includes deliberate practice [ 22 ] of deconstructed skills [ 23 , 24 ], and encourages trainees to learn from their mistakes [ 25 ] on fundamental skills [ 15 ] as well as low-volume-high-risk events [ 26 ]. This curriculum could be supported with the strategic use of video capture [ 27 ] so that the trainees could review their own performance as well as the performances of their peers.…”

Classic Pages of theJournal of ExtraCorporeal Technology

“…In this issue of JECT, Charrière et al (1) report the results of the fourth retrospective perfusion safety survey since Stoney et al (2) and Kurusz et al (3) published their survey results in 1980 and 1986, respectively. As a bonus in this issue, Mark Kurusz comments (4) on Charrière's article and their "carefully collected data.…”