Department of Surgery, The Center for Leadership and Improvement, Dartmouth Medical School, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center Dartmouth College, Lebanon, NH, USA.
Anesth Analg. 2010 Aug;111(2):316-23. doi: 10.1213/ANE.0b013e3181e329f1. Epub 2010 May 20.
The 2007 Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Clinical Practice Guideline for Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery was recently promulgated and has received much attention. Using a survey of cardiac anesthesiologists and perfusionists' clinical practice, we aimed to assess the current practices of perfusion, anesthesia, and surgery, as recommended by the Guidelines, and to also determine the role the Guidelines had in changing these practices.
Nontrainee members of the Society of Cardiovascular Anesthesiologists, the American Academy of Cardiovascular Perfusion, the Canadian Society of Clinical Perfusion, and the American Society of ExtraCorporeal Technology were surveyed using a standardized survey instrument that examined clinical practices and responses to the Guidelines.
A total of 1402 surveys from 1061 institutions principally in the United States (677 institutions) and Canada (34 institutions) were returned, a 32% response rate. There was wide distribution of the Guidelines with 78% of anesthesiologists and 67% of perfusionists reporting having read all, part, or a summary of the Guidelines. However, only 20% of respondents reported that an institutional discussion had taken place as a result of the Guidelines, and only 14% of respondents reported that an institutional monitoring group had been formed. There was wide variability in current preoperative testing, perfusion, surgical, and pharmacological practices reported by respondents. Twenty-six percent of respondents reported 1 or more practice changes in response to the Guidelines. The changes made were reported to be highly (9%) or somewhat (31%) effective in reducing overall transfusion rates. Only 4 of 38 Guideline recommendations were reported by >5% of respondents to have been changed in response to the Guidelines.
Wide variation in clinical practices of cardiac surgery was reported. Little change in clinical practices was attributed to the Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists Guidelines.
2007 年胸外科医师协会和心血管麻醉医师协会发布了《心脏外科围术期输血和血液保护临床实践指南》，该指南受到了广泛关注。本研究采用问卷调查的方式，调查了心脏麻醉师和灌注师的临床实践，旨在评估指南推荐的当前灌注、麻醉和手术实践，并确定指南在改变这些实践中的作用。
使用标准化的调查问卷，对心血管麻醉医师协会、美国心血管灌注学会、加拿大临床灌注学会和美国体外技术协会的非受训成员进行了调查，调查内容包括临床实践和对指南的反应。
共收到来自美国（677 家机构）和加拿大（34 家机构）1061 家主要机构的 1402 份调查回复，回复率为 32%。指南的分布范围很广，78%的麻醉师和 67%的灌注师报告说已阅读过指南全文、部分内容或指南摘要。然而，只有 20%的受访者报告说，由于指南的发布，机构内部进行了讨论，只有 14%的受访者报告说成立了机构监测小组。受访者报告的当前术前检查、灌注、手术和药物治疗实践存在很大差异。26%的受访者报告称，根据指南做出了 1 项或多项实践改变。这些改变被报告为在降低总体输血率方面非常有效（9%）或有些效果（31%）。只有 4/38 项指南建议被>5%的受访者报告称已根据指南做出改变。
报告称心脏外科的临床实践存在很大差异。临床实践的改变很小，这归因于胸外科医师协会/心血管麻醉医师协会指南的影响。
