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Perfusion treatment algorithm: methods of improving the quality of perfusion
Hunter B Holcomb1, Alfred H Stammers, Chen Gao
1Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA. cardiomedic@aol.com
Insights
Cardiopulmonary bypass (CPB) adverse effects can be mitigated by optimizing perfusion variables and using the Mortality Assessment Perfusion Score (MAPS) for risk stratification. This approach improves patient outcomes in cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Perfusion Science
- Medical Technology Assessment
Background:
- Cardiopulmonary bypass (CPB) is associated with negative patient outcomes due to multifactorial causes related to its conduct and extracorporeal flow.
- A shift away from CPB in heart disease treatment necessitates strategies to mitigate its adverse effects.
Purpose of the Study:
- To develop a bedside patient risk assessment tool for creating tailored perfusion care plans.
- To identify controllable CPB variables that positively influence patient outcomes and reduce morbidity.
Main Methods:
- Systematic review of randomized, peer-reviewed human studies to identify optimal perfusion variables (e.g., hematocrit, MAP, temperature, lactate, COP, pulsatile flow, acid-base balance, oxygenation, coated circuits).
- Development of the Mortality Assessment Perfusion Score (MAPS) using the Society of Thoracic Surgeon database (61 variables) for bedside risk stratification.
- Utilizing MAPS to predict patient morbidity and mortality based on historical data.
Main Results:
- Identification of key controllable perfusion variables positively correlated with improved patient outcomes.
- Successful development and validation of the MAPS tool for bedside patient risk assessment.
- Demonstration of MAPS's predictive capability for patient morbidity and mortality.
Conclusions:
- Optimizing CPB conduct and implementing quantitative risk stratification via MAPS can significantly improve patient outcomes.
- A patient treatment algorithm incorporating risk assessment and perfusion variable management is crucial for enhancing surgical results.
Abstract:
The pathophysiological consequence associated with cardiopulmonary bypass (CPB) has generated a movement away from this technology in the treatment of heart disease. The negative outcomes are multifactorial in origin and may be associated both with the conduct of CPB and the instrumentation of extracorporeal flow. The purpose of this study was twofold. First, to develop a bedside patient risk assessment to aid in the development of a perfusion care plan. Second, to identify the controllable variables used during CPB that contribute to overall morbidity. Controllable perfusion-related variables that were positively linked to improved patient outcomes were identified from randomized, peer-reviewed human studies. Such variables as hematocrit, mean arterial pressure, thermic perfusion, blood lactate, colloid osmotic pressure, pulsatile perfusion, acid base homeostasis, oxygenation, and coated circuitry were included. Patient risk assessment was developed using the Society of Thoracic Surgeon database, where 61 variables affecting postoperative morbidity were identified. These variables were used to develop a bedside tool, Mortality Assessment Perfusion Score (MAPS), to guide the perfusion patient care plan. The MAPS generates a specific value that may predict patient morbidity and mortality based on past mortalities. In conclusion, the improvement in patient outcome may be associated with both the change in conduct of CPB and the quantitative assessment of patient risk stratification and a patient treatment algorithm.
