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International Survey of Perfusion Practice for Pediatric and Congenital Heart Surgery: 2021 Results
Ashley B Walczak1, Jordan M Voss1,2,3,4,5,6,7,8, Molly Dreher2
1The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.
Insights
Pediatric perfusion practices are evolving. This 2021 survey reveals widespread use of specific equipment and techniques, with a majority of responses from non-North American centers, highlighting regional variations in pediatric cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Pediatric Perfusion
- Medical Device Technology
Background:
- Pediatric cardiopulmonary bypass techniques are continuously advancing with new devices and methods.
- Periodic surveys since 1989 have tracked pediatric perfusion practices.
- The last survey was conducted in 2016, necessitating an updated perspective.
Purpose of the Study:
- To provide an updated international perspective on pediatric and congenital perfusion practices.
- To assess current trends in equipment, demographics, and techniques.
- To identify regional variations in pediatric perfusion.
Main Methods:
- A 100-question survey was distributed online to 284 pediatric cardiac surgery centers globally in July 2021.
- Unique survey hyperlinks ensured single responses per institution, with weekly reminders for non-respondents.
- Data from 153 centers (54% response rate) were analyzed, with 61% from non-North American institutions.
Main Results:
- The majority of centers utilize roller head arterial pumps (93%), hollow fiber oxygenators with open reservoirs (86%), and integrated arterial line filters (73%).
- Modified ultrafiltration (76%) and selective antegrade cerebral perfusion for aortic arch repairs (92%) are widely adopted.
- The N+1 staffing model (52%) is most common, followed by two perfusionists per case (33%).
Conclusions:
- Periodic surveys remain valuable for assessing regional variations in pediatric perfusion.
- This survey marks a shift, with most responses originating from non-North American centers.
- Identifying practice patterns can guide the development of regional standards, reduce practice variation, and enhance patient safety.
Abstract:
The conduct of cardiopulmonary bypass in neonatal, infant, and pediatric patients continuously evolves as new devices and innovative techniques are introduced. Since 1989, periodic pediatric perfusion surveys have been conducted to ascertain practice patterns involving demographics, equipment, and perfusion techniques. The goal of this current project is to provide an updated perspective on international pediatric and congenital perfusion practice since the last survey conducted in 2016. In July 2021, a 100-question perfusion survey was distributed to 284 pediatric cardiac surgery centers using a secure web browser-based data application. Each center was given a unique survey hyperlink to ensure one response per institution and to monitor the response rate. Centers were given 1 month to complete the survey and electronic reminders were sent weekly to nonrespondents. After the survey was closed, information from completed surveys was exported to a software program for analysis. Responses were received from 153 of 284 pediatric centers for a response rate of 54%. Sixty respondents (39%) were from North American (NA) centers while 93 respondents (61%) were from non-North American (NNA) centers. The vast majority of centers use a roller head arterial pump (93%), hollow fiber oxygenators with open reservoirs (86%), and integrated arterial line filters (73%). The use of modified ultrafiltration was reported by 76% of centers. Ninety-two percent of centers reported the use of selective antegrade cerebral perfusion for aortic arch repairs. The N + 1 staffing model was most prevalent (52%), followed by two perfusionists per case (33%). Periodic surveys continue to be a useful modality in assessing regional variation in pediatric perfusion practice. This survey marked the first time the majority of responses came from non-North American institutions. Identifying these practice patterns may aid in the development of, and adherence to, regional standards and guidelines. This would foster the reduction of variation in practice and potentially improve patient safety.
