Adult cardiopulmonary bypass in Australian and New Zealand public hospitals: A survey of practice.

Abstract

A telephone survey of cardiac anaesthetists and perfusionists at the 29 public hospitals providing adult cardiac surgical services in Australia and New Zealand was carried out between December 2019 and January 2020. The aim was to investigate current practice with regard to selected contentious elements of anaesthetic and perfusion management during cardiopulmonary bypass; primarily relating to bypass circuit priming, blood conservation methods and point-of-care coagulation testing. There was a 100% response rate. The average number of adult public cardiopulmonary bypass cases per hospital was 508 (160-1400). For cardiopulmonary bypass cases, ten hospitals (34%) routinely used a cell saver and the remainder used a cell saver selectively. Residual blood remaining in the cardiopulmonary bypass circuit was processed using a cell saver routinely in four hospitals (14%) and selectively in 23 (79%). Acute normovolaemic haemodilution was rarely used. Retrograde autologous priming was used routinely in seven hospitals (24%) and selectively in 16 (55%). All hospitals had access to point-of-care coagulation testing. The majority of hospitals targeted an activated clotting time of 480 s (range 400-500 s) prior to commencing cardiopulmonary bypass. There was marked geographic variation in access to fibrinogen concentrate. The cardiopulmonary bypass circuit prime solution was primarily a balanced crystalloid in most hospitals; however, there was significant variation regarding the addition of human albumin, mannitol, sodium bicarbonate and other medications. Many of the interventions examined were used on a case-by-case basis. These findings support the need for further research to define more evidence-based practice of these interventions.