Standards and Guidelines for Perfusion Practice
Published by American Society of ExtraCorporeal Technology (AmSECT)
Summary
AI-generatedThe 2023 AmSECT Standards and Guidelines for Perfusion Practice outlines 19 mandatory standards and associated guidelines for adult cardiopulmonary bypass (CPB). Key topics include institutionally-based protocols, staffing, safety devices, patient monitoring, anticoagulation, blood flow and management, and crisis management.
Key Takeaways
- 1Institutions must develop, implement, and annually review specific operating protocols for all standards of cardiopulmonary bypass.
- 2CPB procedures must be conducted by qualified, board-certified Perfusionists whose competency is assessed annually.
- 3Continuous and continual monitoring of patient hemodynamics, blood flow, blood gas, and device temperatures is strictly mandated.
- 4Checklists must be utilized for each cardiopulmonary bypass procedure and included in the patient's permanent record.
- 5A collaborative, actionable crisis management plan must be implemented to handle unforeseen circumstances and supply chain interruptions.
What's New in This Version
The 2022 update includes extensive modifications to existing standards and guidelines to enhance their interpretation and use. It also introduces Standard 19, which focuses on crisis management.
Key Recommendations
Standard 1: Development of Institutionally-based Protocols
- Standard 1.1
As a mechanism for applying each standard to clinical practice, an institution or service provider shall develop and implement an operating procedure (protocol) for each of the standards.
MandatoryProtocol Development
Standard 2: Qualification, Competency and Support Staff
- Standard 2.1
A Perfusionist, who is Board Certified by the American Board of Cardiovascular Perfusion or who demonstrates equivalent qualifications and competency, shall conduct cardiopulmonary bypass procedures.
MandatoryStaffing/Qualifications
Standard 3: Communication
- Standard 3.1
A patient-specific management plan for the cardiopulmonary bypass procedure shall be prepared and communicated to the surgical team either during the pre-operative briefing or prior to beginning the procedure.
MandatoryCommunication
Standard 4: Perfusion Record
- Standard 4.1
The perfusion record (written and/or electronic) for each cardiopulmonary bypass (CPB) procedure shall be included as part of the patient’s permanent medical record.
MandatoryDocumentation
Standard 5: Checklist
- Standard 5.1
The Perfusionist shall use a checklist for each cardiopulmonary bypass procedure.
MandatorySafety
Standard 6: Safety Devices
- Standard 6.1
Pressure monitoring of the arterial line, cardioplegia delivery systems and venous reservoir (when augmented venous drainage is utilized) shall be employed during cardiopulmonary bypass procedures.
MandatoryEquipment/Safety
Standard 7: Monitoring
- Standard 7.1
Patient arterial blood pressure shall be monitored continuously during cardiopulmonary bypass procedures.
MandatoryMonitoring
Standard 8: Anticoagulation
- Standard 8.1
The Perfusionist, in collaboration with the supervising physician, shall define the intended anticoagulation management algorithm.
MandatoryClinical Management
Standard 9: Gas Exchange
- Standard 9.1
Gas exchange shall be maintained during cardiopulmonary bypass support procedures according to protocol, accounting for individual patient needs.
MandatoryClinical Management
Standard 10: Blood Flow
- Standard 10.1
Target blood flow rates shall be determined prior to cardiopulmonary bypass according to protocol.
MandatoryClinical Management
Standard 11: Blood Pressure
- Standard 11.1
The Perfusionist, in collaboration with the surgical care team, shall define and communicate the intended treatment algorithm for blood pressure management prior to cardiopulmonary bypass procedures.
MandatoryClinical Management
Standard 12: Protamine and Cardiotomy Suction
- Standard 12.1
Cardiotomy suction shall be discontinued at the onset of protamine administration to avoid clotting within the cardiopulmonary bypass circuit.
MandatoryClinical Management
Standard 13: Blood Management
- Standard 13.1
The Perfusionist shall utilize the timely and collaborative application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss.
MandatoryClinical Management
Standard 14: Level of Readiness
- Standard 14.1
Procedures identified preoperatively to be at elevated risk of requiring conversion to a cardiopulmonary bypass procedure shall have a protocol for transition to such procedures.
MandatoryProtocol Development
Standard 15: Staffing and On-call
- Guideline 15.1
The “n+1” staffing model should be utilized at all times, where “n” equals the number of operating/procedure rooms in use at any given time at a single site.
RecommendationStaffing
Standard 16: Duty Hours
- Standard 16.1
In order for the Perfusionist to ensure proper provision of care, he/she shall receive an adequate rest period between scheduled work hours.
MandatoryStaffing
Standard 17: Quality Assurance and Improvement
- Standard 17.1
The Perfusionist shall actively participate in both institutional and departmental quality assurance and improvement programs, and safety reporting systems.
MandatoryQuality Assurance
Standard 18: Maintenance
- Standard 18.1
The Perfusionist shall ensure that equipment used in the conduct of cardiopulmonary bypass is properly maintained and functioning, including cleaning and disinfecting.
MandatoryEquipment Maintenance
Standard 19: Crisis Management
- Standard 19.1
The perfusionist shall participate in a collaborative effort to implement an actionable crisis management plan for unforeseen circumstances that may prohibit the ability to perform standard duties.
MandatoryCrisis Management
Scope & Objectives
Clinical Topic
Cardiopulmonary Bypass and Extracorporeal Support
Objectives
To provide Perfusionists with a framework to guide safe and effective extracorporeal support care to their patients and assist teams in developing institution-specific protocols.
Target Patient Population
Adults
Target Providers
Patient Criteria & Setting
Therapeutic Area
CardiovascularGuideline Scope
Exclusion Criteria
- Pediatric patients
Care Settings
Safety & Contraindications
Monitoring Guidance
Requires continuous monitoring of patient arterial blood pressure, arterial line pressure, and arterial blood flow. Continual monitoring is required for cardioplegia dose, patient and device temperatures, blood gas analyses, hematocrit, oxygen fraction, and venous oxygen saturation.
Authors & Contributors
Guideline Features
Learning Context
Difficulty
advanced
Exam Relevance
Learning Paths