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Published by American Society of ExtraCorporeal Technology (AmSECT)
The 2023 AmSECT Standards and Guidelines for Perfusion Practice outlines 19 mandatory standards and associated guidelines for adult cardiopulmonary bypass (CPB). Key topics include institutionally-based protocols, staffing, safety devices, patient monitoring, anticoagulation, blood flow and management, and crisis management.
Key Takeaways
The 2022 update includes extensive modifications to existing standards and guidelines to enhance their interpretation and use. It also introduces Standard 19, which focuses on crisis management.
As a mechanism for applying each standard to clinical practice, an institution or service provider shall develop and implement an operating procedure (protocol) for each of the standards.
A Perfusionist, who is Board Certified by the American Board of Cardiovascular Perfusion or who demonstrates equivalent qualifications and competency, shall conduct cardiopulmonary bypass procedures.
A patient-specific management plan for the cardiopulmonary bypass procedure shall be prepared and communicated to the surgical team either during the pre-operative briefing or prior to beginning the procedure.
The perfusion record (written and/or electronic) for each cardiopulmonary bypass (CPB) procedure shall be included as part of the patient’s permanent medical record.
The Perfusionist shall use a checklist for each cardiopulmonary bypass procedure.
Pressure monitoring of the arterial line, cardioplegia delivery systems and venous reservoir (when augmented venous drainage is utilized) shall be employed during cardiopulmonary bypass procedures.
Patient arterial blood pressure shall be monitored continuously during cardiopulmonary bypass procedures.
The Perfusionist, in collaboration with the supervising physician, shall define the intended anticoagulation management algorithm.
Gas exchange shall be maintained during cardiopulmonary bypass support procedures according to protocol, accounting for individual patient needs.
Target blood flow rates shall be determined prior to cardiopulmonary bypass according to protocol.
The Perfusionist, in collaboration with the surgical care team, shall define and communicate the intended treatment algorithm for blood pressure management prior to cardiopulmonary bypass procedures.
Cardiotomy suction shall be discontinued at the onset of protamine administration to avoid clotting within the cardiopulmonary bypass circuit.
The Perfusionist shall utilize the timely and collaborative application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss.
Procedures identified preoperatively to be at elevated risk of requiring conversion to a cardiopulmonary bypass procedure shall have a protocol for transition to such procedures.
The “n+1” staffing model should be utilized at all times, where “n” equals the number of operating/procedure rooms in use at any given time at a single site.
In order for the Perfusionist to ensure proper provision of care, he/she shall receive an adequate rest period between scheduled work hours.
The Perfusionist shall actively participate in both institutional and departmental quality assurance and improvement programs, and safety reporting systems.
The Perfusionist shall ensure that equipment used in the conduct of cardiopulmonary bypass is properly maintained and functioning, including cleaning and disinfecting.
The perfusionist shall participate in a collaborative effort to implement an actionable crisis management plan for unforeseen circumstances that may prohibit the ability to perform standard duties.
Clinical Topic
Cardiopulmonary Bypass and Extracorporeal Support
Objectives
To provide Perfusionists with a framework to guide safe and effective extracorporeal support care to their patients and assist teams in developing institution-specific protocols.
Target Patient Population
Adults
Target Providers
Therapeutic Area
CardiovascularGuideline Scope
Exclusion Criteria
Care Settings
Monitoring Guidance
Requires continuous monitoring of patient arterial blood pressure, arterial line pressure, and arterial blood flow. Continual monitoring is required for cardioplegia dose, patient and device temperatures, blood gas analyses, hematocrit, oxygen fraction, and venous oxygen saturation.
Difficulty
advanced
Exam Relevance
Learning Paths