Milojevic Milan, Milosevic Goran, Nikolic Aleksandar, Petrovic Masa, Petrovic Ivana, Bojic Milovan, Jagodic Sinisa
Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia.
Erasmus University Medical Center, Department of Cardiothoracic Surgery, 3015 GD Rotterdam, The Netherlands.
J Cardiovasc Dev Dis. 2023 Jul 12;10(7):296. doi: 10.3390/jcdd10070296.
The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.
心脏外科手术的成功结果在很大程度上取决于体外循环（CPB）的管理。即使心脏手术在技术上操作良好，患者仍可能出现与CPB相关的并发症，这些并发症可能导致严重的合并症、生活质量下降，甚至死亡。然而，临床灌注师在围手术期患者护理中的关键作用却常常被忽视。因此，欧洲心胸外科学会（EACTS）、欧洲心胸麻醉学会（EACTA）和欧洲心血管灌注委员会（EBCP）已同意制定关于CPB的联合临床实践指南（CPG），因为它对患者护理有重大影响，且各国的实践模式存在显著差异。基于EACTS制定CPG的标准化框架的欧洲指南涵盖了成人心脏手术中CPB管理的各个方面。这包括临床灌注师的培训和教育、机器硬件、一次性用品、CPB启动准备、CPB期间有助于维持终末器官功能和抗凝的全套程序、脱离CPB以及证据空白和未来研究方向。这种全面覆盖确保了CPB管理的各个方面都得到解决，为临床医生提供了一种基于最新证据和最佳实践的标准化CPB管理方法。为了确保将这些基于证据的建议更好地融入日常实践，本综述旨在提供对指南制定的总体理解以及CPB管理基本治疗建议的概述。
