Variation in arterial inflow temperature: a regional quality improvement project

Area of Science:

• Cardiovascular Surgery
• Quality Improvement
• Perfusion Technology

Background:

• Peer-reviewed evidence recommends limiting arterial blood temperature to 37°C during cardiopulmonary bypass.
• Regional variability in adherence to this recommendation was observed across medical centers.

Purpose of the Study:

• To implement a regional quality improvement initiative to reduce variability in arterial blood temperature management during cardiopulmonary bypass.
• To decrease patient exposure to elevated arterial blood temperatures in isolated coronary artery bypass grafting procedures.

Main Methods:

• A collaborative quality improvement initiative involving four northern New England medical centers from January 2006 to June 2010.
• Cardiovascular perfusionists discussed evidence-based recommendations and strategies for temperature management.
• Data on highest arterial blood temperatures were collected prospectively through a regional perfusion registry for 4909 procedures.

Main Results:

• Prior to interventions, 90% of procedures exceeded 37°C; post-intervention, this decreased to 69% (p < .001).
• Temperatures exceeding 37.5°C dropped from 53% to 19% (p < .001) after the quality improvement initiative.
• Three of the four centers demonstrated a significant sustained reduction in high arterial outflow temperatures.

Conclusions:

• A regional quality improvement initiative effectively reduced elevated arterial blood temperatures during cardiopulmonary bypass.
• Regional perfusion registries are valuable tools for assessing performance and the success of quality improvement efforts.
• Sustained adherence to evidence-based temperature guidelines can improve patient safety during cardiac surgery.