Donald S. Likosky, PhD
Robert A. Baker, PhD, CCP (Aust)
Objective: Describe the process by which writing groups can be formed to implement the process of producing guideline documents. To introduce the current writing group and highlight how it was established, how it is managed and the direction of the current work it is undertaking.
The International Consortium for Evidence-Based Perfusion (ICEBP) was born out of the vision statement for President -elect (now AMSECT President Al Stammers), an epidemiologist and a group of perfusionists who recognized the need to convert the growing mass of published work in the field of perfusion and related disciplines into an active, iterative process directed towards the continuous improvement of the delivery of care and outcomes for surgical patients.
As part of the mission statement the group was charged with: "Developing evidence based guidelines for extracorporeal circulation."
A model already exists for how to develop such guidelines, and is readily accessible (http://www.americanheart.org/downloadable/heart/1148391822076Methodology_Manual_for_ACC_AHA.pdf). The ACC/AHA guidelines provide enormous detail regarding the structure and content of clinical guidelines. Using this foundation as a guide, we have formed the first formal AMSECT Writing Group.
The infrastructure for this process includes a biomedical librarian, as well as dedicated clinical colleagues. So who is on this writing group and how do you get there? The process of drawing together interested individuals is the first step in this process. While less formal, much of this foundational work had informally already commenced (1). The ICEBP writing group, which will always be dynamic in nature (ie forever changing in membership), currently consists of a group of individuals who participated in the JCTVS manuscript as well as others who have self-selected themselves through contacting members of the ICEBP. At this stage we have a writing group of 26. Additionally, the doorway is always open for interested individuals.
What is the group up to? Harder than getting a group of people together is the job of deciding what areas would be reviewed with the possibility of delivering useful guidelines for the perfusion community. Through iterative face-to-face, as well as electronic communications, topics for the 1st ICEBP guidelines will be platelet preservation and inflammatory response. A general outline of the guidelines follow below:
Platelet Preservation
1) Defining the problem
2) Platelet function monitoring (TEG)
3) Strategies for platelet preservation (ANH, avoidance of shed blood, etc)
4) Coated circuits
5) Pharmacologic strategies
Inflammatory Response
1) Defining the problem
2) Strategies for reducing inflammatory response
a) technique: diverting blood to cell saver, reducing embolization, ultrafiltration, limit ischemia
b) technology: coated circuits (tip-to-tip vs. other or not at all), roller vs. centrifugal pumps, ultrafiltration
c) pharamcologic strategies
The next task is assigning interested participants to the different topics. We are currently in this process. Likosky and Baker will discuss this process in more detail, and identify opportunities for further collaboration with the perfusion community.
