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Evidence-based algorithm for heparin dosing before cardiopulmonary bypass. Part 1: Development of the algorithm
Mark C McKinney1, Jeffrey B Riley
1Columbus Childrens Hospital, Columbus, Ohio, USA. mckinney.189@osu.edu
The Journal of Extra-Corporeal Technology
|February 26, 2008
Summary
Heparin resistance affects 15%-20% of adult cardiac surgeries. An evidence-based algorithm, using anti-thrombin III for treatment, was developed to standardize care and manage heparin resistance during cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Heparin resistance occurs in 15%-20% of adult cardiac surgeries using cardiopulmonary bypass.
- Standardized heparin dosing protocols are needed to improve patient care and reduce complications.
Purpose of the Study:
- To develop and validate an evidence-based clinical decision-making algorithm for managing heparin resistance.
- To improve consistency in patient care and optimize heparin dosing during cardiopulmonary bypass.
Main Methods:
- A literature search for high-level evidence on heparin resistance diagnosis and treatment.
- Surveys of practicing perfusionists to gather expert opinion and validate the algorithm.
- Algorithm construction based on evidence and expert consensus, defining resistance as ACT < 450s with > 450 IU/kg heparin, with anti-thrombin III supplementation as treatment.
Main Results:
- An evidence-based algorithm for heparin resistance management was constructed.
- The algorithm's face validity was confirmed by practicing perfusionists.
- The algorithm incorporates patient history predictors and defines resistance with a specific ACT and heparin dose threshold.
Conclusions:
- The developed algorithm for heparin resistance is evidence-based and supported by clinician opinion.
- The algorithm provides a standardized approach to heparin resistance during cardiopulmonary bypass.
- A randomized clinical trial is proposed to compare the algorithm against current standard practice.
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