Timothy Dickinson, MS
Purpose: The recent landmark publication by Shann et al entitled, “An evidence-based review of the practice of cardiopulmonary bypass in adults: A focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response”[1] provides eight recommended guidelines for cardiopulmonary bypass practice. As the authors mention, there are wide variations in the use of technology and techniques for conducting cardiopulmonary bypass (CPB) despite a preponderance of evidence supporting key principles in managing safe and effective CPB practice. The purpose of this study was to examine and measure, at a national level, the variation of practice to three of the guidelines stated in the Shann et al paper.
Method: For the past several years, Fresenius Medical Care Extracorporeal Alliance has utilized its Quality Indicator Program to universally collect and report on three of the eight guidelines (Avoidance of hypothermia, Maintenance of euglycemia and Reduction of hemodilution) stated in the Shann et al paper. This clinical data is universally collected and entered into our Quality Indicator Program on every adult open-heart procedure performed at 165 hospitals in 34 different states and representing 32,750+ procedures annually.
Results: Adoption to the above three listed evidence-based guidelines were measured by geographical regions for the second quarter of 2006. Conformance to these guidelines was found to vary by geographical region.
Conclusions: Variation in conformance to evidence-based guidelines related to adult CPB practices were found at a national level. Identifying the existence of a gap in clinical practice versus evidence-based knowledge is the first step in reducing the practice variation and improving patient care.
