PDF(Pubmed)
Abstract：
Background: Cardiovascular perfusion is a dynamic healthcare profession where new practices are frequently introduced. Despite the emergence of evidence-based clinical practice guidelines, little is known about their dissemination at the institutional level. Clinical practice surveys have been used to identify current trends in perfusion practice in the areas of equipment, techniques, and staffing. This survey aims to describe clinical perfusion practices across adult cardiac surgical programs located in a large, single, geographical region of the United States. Methods: Following Institutional Review Board (IRB) approval, an 81-question survey was distributed to 167 adult perfusion programs across the Zone IV region of the American Society of Extracorporeal Technology (AmSECT), a non-profit professional society representing the extracorporeal technology community. Surveys were distributed to chief perfusionists through the Research Electronic Data Capture (REDCap) web-based survey response system. Results: Responses were received from 58 of 167 centers across (34.7% response rate). Centrifugal pumps were used at 81% (n = 47) of centers and 96.6% (n = 56) use an open venous system or hard-shell venous reservoir. Del Nido was the most frequently used cardioplegia strategy with 62.1% (n = 36) of centers reporting its use. The use of electronic medical records was reported in 43% (n = 25) of centers, while 84.5% (n = 49) reported using Cardiopulmonary Bypass (CPB) protocols (>75% of all CPB activities). Extracorporeal Membrane Oxygenation (ECMO) support was reported in 93.1% (n = 54) of programs, with 59.2% of programs (n = 34) employing a perfusionist as ECMO Coordinator. The n + 1 staffing model was reported by 50% (n = 29), with 24% supporting the n + 1 staffing for after-hours and on-call procedures. Conclusion: Clinical practice surveys can be effective tools to inform clinicians about contemporary perfusion practice and identify deviations from professional standards and guidelines. Subsequent surveys may describe trends over time, assess standardization of practice, measure adherence to evidence-based guidelines, and foster improved patient care and outcomes.
摘要：
背景：心血管灌注是一个动态的医疗保健行业，经常引入新的实践。尽管出现了循证临床实践指南，对它们在机构层面的传播知之甚少。临床实践调查已用于确定设备领域灌注实践的当前趋势，技术,和人员配备。这项调查旨在描述成人心脏外科手术的临床灌注实践，单身,美国的地理区域。方法：在机构审查委员会(IRB)批准后，一项81个问题的调查分发给了美国体外技术协会（AmSECT）IV区的167个成人灌注计划，代表体外技术社区的非营利性专业协会。通过基于网络的调查响应系统，将调查分发给首席灌注师。结果：来自167个中心中的58个中心（反应率为34.7％）。在81％（n=47）的中心使用离心泵，而96.6％（n=56）的中心使用开放静脉系统或硬壳静脉储液器。DelNido是最常用的心脏停搏策略，有62.1％（n=36）的中心报告其使用。据报道，43%(n=25)的中心使用电子病历，而84.5%(n=49)报告使用体外循环(CPB)方案(>75%的所有CPB活动)。在93.1%(n=54)的项目中报告了体外膜氧合(ECMO)支持，59.2%的项目(n=34)采用灌注师作为ECMO协调员。n+1人员配备模式报告了50%(n=29)，24%的人支持n+1员工的下班后和待命程序。结论：临床实践调查可以成为有效的工具，使临床医生了解当代灌注实践并确定与专业标准和指南的偏差。随后的调查可能会描述一段时间以来的趋势，评估实践的标准化，衡量对循证指南的遵守情况，并促进改善患者护理和预后。
