What are the minimal criteria of goal-directed perfusion (GDP) in adult cardiac surgery?

Abstract

Introduction: Nowadays, many cardiac surgery teams are adopting the goal-directed perfusion (GDP) strategy in their practice to maintain optimal perfusion during cardiac surgeries and improve patient outcomes. Furthermore, it plays an indispensable role as a quality control tool to monitor both perfusionists’ practice and equipment (in addition to disposables used in the surgery. Objectives: To identify the role and the elements of GDP that facilitate better surgical outcomes. In addition, to compare between GDP and the traditional conventional perfusion strategy (CP) in terms of perfusion adequacy and surgical outcomes. Finally, to recognize challenges that may prevent the effective application of GDP and finding possible applicable solutions. Methods: A systematic literature review was conducted from three different databases PubMed, SpringerLink, and ScienceDirect. The selected studies were in English from the USA and Europe with a time frame starting from 2005. Results: The findings highlight the crucial role of the GDP strategy in protecting and preserving end-organ function after on-bypass cardiac surgery procedures. Furthermore, a clear understanding of the GDP implementation component and criteria was obtained. Alternatively, a satisfactory GDP level can be achieved by the optimal utilization of available resources. Discussion: Dismantling the GDP strategy into practically recognized components to ease the implementation at different levels of perfusion practice. Conclusion: The GDP approach involves the intensive monitoring of respiratory-related parameters to enhance surgical outcomes. The process includes blood preservation, optimal flow and intraoperative parameters management. Monitoring is the key element of GDP, which can be applied by using the sophisticated technology or the proper use of existing resources to develop protocols within the international guidelines and recommendations. Achieving an optimal perfusion requires concerted efforts of organizational, safety, and practical measurements.