Baker Robert A, Willcox Timothy W
Department of Cardiac and Thoracic Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
J Extra Corpor Technol. 2006 Sep;38(3):220-9.
The current practice of perfusion in Australia and New Zealand continues to adopt new techniques and procedures into clinical practice. Our aims were to report current practice in 2003 and to compare and contrast current practice with historic practice. A total of 62 centers (40 perfusion groups) performing procedures using cardiopulmonary bypass (CPB) were identified and were e-mailed a detailed electronic survey. The survey was comprised of an excel worksheet that contained 233 single answer questions (either dropdown lists, yes/no, true/false, or numeric) and 12 questions that allowed the respondent to provide a commentary. Respondents were instructed to answer all questions based on what represented the predominant practice of perfusion in their institutions during 2003. We report an 89% response rate representing a caseload of 20,688 adult cases. These data allowed us to profile the following. A standard adult CPB setup in 2003 consisted of a membrane oxygenator (100% of cases), a roller pump (70%) as the main arterial pump, although a centrifugal pump would be considered for selected procedures (30%), a circuit incorporating a hard-shell venous reservoir (86%), and a mixture of biocompatible and non-biocompatible circuit components (66%). The circuit would include a pre-bypass filter (88%), an arterial line filter (94%), and would allow monitoring of the following: hard-shell venous reservoir low level (100%) with servo-regulation of the arterial pump (85%), microbubble alarm (94%) with servo-regulation of the arterial pump (79.5%), arterial line pressures (100%) with servo-regulation of the arterial pump (79%), inline venous O2 saturation (100%), and inline hematocrit (58%). Perfusion practice in Australia and New Zealand has adopted changes over the last decade; however, some areas of practice show wide variation. This survey provides a baseline of contemporary practice for Australian and New Zealand perfusionists.
澳大利亚和新西兰目前的灌注实践持续将新技术和程序应用于临床实践。我们的目的是报告2003年的当前实践情况,并将当前实践与历史实践进行比较和对照。共确定了62个使用体外循环(CPB)进行手术的中心(40个灌注组),并通过电子邮件向其发送了一份详细的电子调查问卷。该调查问卷由一个Excel工作表组成,其中包含233个单项选择题(下拉列表、是/否、真/假或数字形式)以及12个允许受访者发表评论的问题。受访者被要求根据2003年其所在机构灌注的主要实践情况回答所有问题。我们报告的回复率为89%,代表20688例成人病例的病例数。这些数据使我们能够描述以下情况。2003年标准的成人CPB装置包括一个膜式氧合器(100%的病例)、一台滚压泵(70%)作为主要动脉泵,不过对于某些特定手术会考虑使用离心泵(30%)、一个包含硬壳静脉储血器的回路(86%)以及生物相容性和非生物相容性回路组件的混合(66%)。该回路将包括一个预旁路过滤器(88%)、一个动脉管路过滤器(94%),并允许监测以下各项:硬壳静脉储血器低液位(100%)并对动脉泵进行伺服调节(85%)、微气泡警报(94%)并对动脉泵进行伺服调节(79.5%)、动脉管路压力(100%)并对动脉泵进行伺服调节(79%)、在线静脉血氧饱和度(100%)以及在线血细胞比容(58%)。在过去十年中,澳大利亚和新西兰的灌注实践发生了变化;然而,某些实践领域仍存在很大差异。这项调查为澳大利亚和新西兰的灌注师提供了当代实践的基线。