2016 survey about temperature management during extracorporeal circulation in China

Incidence, factors, and prognostic analyses of challenging cardiopulmonary bypass separation in Chinese cardiac surgical populations

BACKGROUND

Challenging separation from cardiopulmonary bypass (CPB) has been associated with multiple medical adversities, while its incidence, associated factors, and prognosis among cardiac surgery populations are substantially understudied.

METHODS

Adult cardiac surgical patients in two medical centers were retrospectively analyzed. Separation from CPB was stratified as easy, difficult, or complex, based on the use of pharmacologic assistance agents and mechanical supports. The various in-hospital adverse outcomes (e.g., mortality, common complications) were assessed.

RESULTS

The incidence of difficult and complex separation from CPB was 21.9% (1159 cases, 95% CI 20.8% to 23.1%), and 6.1% (320 cases, 95% CI 5.4% to 6.7%), respectively. High age, the presence of pulmonary hypertension or unstable angina, decreased ejection fraction, and emergency surgery were more frequently associated with challenging separation from CPB. Patients who experienced challenging separation from CPB had an elevated risk of adverse outcomes, including in-hospital mortality (complex: odds ratio [OR] 2.85), composite infection events (difficult: OR=1.82; complex: OR=1.88), major adverse cardiac events (difficult: OR=1.40; complex: OR=1.57), pulmonary complications (difficult: OR=1.31; complex: OR=1.20), acute kidney injury (difficult: OR=1.75; complex: OR=2.64), and prolonged postoperative hospital stays.

CONCLUSIONS

We depicted the incidence of challenging separation from CPB among cardiac surgery population. Additionally, results of influential factors and various adverse outcome analyses emphasize the potential of interventions aimed at preventing difficult or complex separation from CPB and reducing associated adverse outcomes.

Temperature management on cardiopulmonary bypass: Is it standardised across Great Britain and Ireland?

Temperature management is an essential element of cardiopulmonary bypass (CPB), as indicated in the Guide to Good Practice in Clinical Perfusion, 'The safe conduct of CPB requires the clinical perfusionist to measure and control. . . blood temperature. . . during the period of bypass'. To review current practice, we have conducted a research survey into the management of temperature on CPB. Surveys were distributed to each centre in Great Britain and the Republic of Ireland, investigating numerous temperature management practices, to elucidate current practice and assess if recent research into temperature management marry routine clinical practice. Our results demonstrate that nasopharyngeal temperature is the most common (52%) temperature site used across the many centres, which correlates with previous research as a routine site for cerebral temperature management. The arterial outlet of the oxygenator temperature was used in 33% of centres, however, all centres lacked the knowledge to maintain this temperature below 37°C. There was significant variation between all centres, especially regarding rewarming times (20-40 minutes), demonstrating a lack of uniformity among perfusion centres. Interestingly, most centres have been using the same protocol that has been in place over the previous 10 years.To conclude, the practice of temperature management is changing with the awareness of new research. Lower target temperatures are recommended for rewarming, ensuring a lower temperature gradient and a longer mean rewarming time.

Investigation of myocardial protection during pediatric CPB: Practical experience in 100 Chinese hospitals

Many measures have been proposed for myocardial protection in pediatric congenital heart surgeries, but little data is available for China. This study investigates myocardial protection strategies in pediatric cardiopulmonary bypass (CPB) throughout China. Online questionnaires were delivered to 100 hospitals in 27 provinces. The number of yearly on-pump pediatric cardiovascular surgeries in these hospitals varied greatly. About 91.0% of respondents believe that each surgery should have at least two perfusionists, while only 64.0% of hospitals actually met this requirement. For pediatric patients, crystalloid cardioplegia was more prevalent than blood-based cardioplegia. Histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid solution were dominant among crystalloid cardioplegia. Del Nido cardioplegia and St. Thomas blood-based cardioplegia ranked the top two in the popularity of blood-based cardioplegia. Dosages varied among different kinds of cardioplegia. In the choice of different cardioplegia, perfusionists mainly focused on myocardial protective effect and cost. Hypothermia of cardioplegia solution was maintained by ice buckets in 3/4 of the hospitals in this survey. In conclusion, the essence of myocardial protection management during pediatric CPB was cardiac arrest induced by cardioplegia under systemic hypothermia. However, there is no uniform standard for the type of cardioplegia, or dosages. Therefore, well-designed multicenter randomized controlled trials are warranted to provide tangible evidence for myocardial protection of cardioplegia in pediatric CPB.