[Patient safety in cardiopulmonary bypass; unusual problems and managements].

Since most of the facilities that conduct open heart surgery in Japan are small and do small numbers of cases each year, many modifications of circuit design in cardiopulmonary bypass (CPB) are commonly found in individual centers. In 2007, under the guidance of the Ministry of Health, Labour and Welfare, a committee consisting of members from 4 medical societies and 1 medical device manufacture association released the Japanese CPB guidelines. The aim was to standardize CPB hardware and software for patient safety and education. The guidelines include heart-lung machines, circuit designs, safety devices and monitoring equipment, perfusion practices, training and education of perfusionists, as well as emergency crisis drills and safety education. To establish safe CPB performance, education of and team work between perfusionists and cardiac surgeons are most important. For the purpose of ensuring patient's safety during CPB, common and conceivable troubles as well as major accidents in the literature should be well studied, methods of prevention should be validated, and methods of "bail-out" from the trouble should be thoroughly practiced.