Objective: Review current guidelines that have been put forth from a variety of professional organizations thus far and on the horizon, and critically review their impact on clinical perfusion.
In order to redesign our perfusion practice to become patient-centered and evidence-based we need to develop contemporary guidelines. These guidelines would be created from the current available evidence. Guidelines would then need to be implemented into practice and subjected to rigorous evaluation.
The American College of Cardiology (ACC) and the American Heart Association (AHA) have jointly engaged in the development of guidelines in the area of cardiovascular disease since 1980. Most recently in 2004, the coronary artery bypass graft surgery guidelines were updated in order to reflect contemporary evidence.1 Unfortunately, these guidelines do not focus specifically on the practice of cardiopulmonary bypass (CPB).
The American Society of Extra-Corporeal Technology (www.amsect.org) and the American Academy of Cardiovascular Perfusion (http://users.aol.com/officeaacp/other/stds.htm) websites provide suggested guidelines for perfusion practice. These guidelines provide recommendations regarding such items as checklists, staffing and anticoagulation management. Although these recommendations are fundamentally important to the practice of perfusion, they fall short of providing the practicing clinician opportunities for practice improvement.
More recently a multidisciplinary group of individuals have adopted the methodology promulgated by the ACC/AHA on guideline writing in order to develop recommendations that focus on the practice of CPB.2 The authors chose to focus on neurologic protection, euglycemia, hemodilution and the inflammatory response. The recommendations are related to specific process variables that have been associated with improved outcomes secondary to cardiac surgery.
This talk will introduce the attendees to the importance of practice guidelines. Current available guidelines will be reviewed and discussed.
Current Guidelines for PerfusionReferences1. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. Oct 5 2004;110:e340-437.2. Shann KG, Likosky DS, Murkin JM et al. An Evidence-Based Approach to Improving the Practice of Cardiopulmonary Bypass in Adults. J Thorac Cardiovasc Surg 2006;132:283-90. |
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