Perfusion treatment algorithm: methods of improving the quality of perfusion.
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.
Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA. cardiomedic@aol.com
Hunter B
HB
Holcomb
Alfred H
AH
Stammers
Chen
C
Gao
Bernadette
B
Nutter
Tina
T
Ellis
Rebecca L
RL
Ahlgren
Ryan G
RG
Schmer
Lynette M
LM
Hock
D000465:Algorithms; D002315:Cardiopulmonary Bypass / Q000401:mortality / Q000592:standards*; D006400:Hematocrit; D006464:Hemoperfusion / Q000401:mortality / Q000592:standards*; D006801:Humans; D019344:Lactic Acid / Q000032:analysis; D009997:Osmotic Pressure; D010347:Patient Care Planning; D011673:Pulsatile Flow; D011785:Quality Assurance, Health Care; D018570:Risk Assessment / Q000145:classification*; D012709:Serum Albumin / Q000032:analysis
D012709:Serum Albumin; D019344:Lactic Acid