1887
1-Thesis
  • EISSN: 2223-506X

Abstract

Nowadays, many cardiac surgery teams are adopting the goal-directed perfusion (GDP) strategy in their practice to maintain optimal perfusion during cardiac surgeries and improve patient outcomes. Furthermore, it plays an indispensable role as a quality control tool to monitor both perfusionists’ practice and equipment (in addition to disposables used in the surgery.

To identify the role and the elements of GDP that facilitate better surgical outcomes. In addition, to compare between GDP and the traditional conventional perfusion strategy (CP) in terms of perfusion adequacy and surgical outcomes. Finally, to recognize challenges that may prevent the effective application of GDP and finding possible applicable solutions.

A systematic literature review was conducted from three different databases PubMed, SpringerLink, and ScienceDirect. The selected studies were in English from the USA and Europe with a time frame starting from 2005.

The findings highlight the crucial role of the GDP strategy in protecting and preserving end-organ function after on-bypass cardiac surgery procedures. Furthermore, a clear understanding of the GDP implementation component and criteria was obtained. Alternatively, a satisfactory GDP level can be achieved by the optimal utilization of available resources.

Dismantling the GDP strategy into practically recognized components to ease the implementation at different levels of perfusion practice.

The GDP approach involves the intensive monitoring of respiratory-related parameters to enhance surgical outcomes. The process includes blood preservation, optimal flow and intraoperative parameters management. Monitoring is the key element of GDP, which can be applied by using the sophisticated technology or the proper use of existing resources to develop protocols within the international guidelines and recommendations. Achieving an optimal perfusion requires concerted efforts of organizational, safety, and practical measurements.

Loading

Article metrics loading...

/content/journals/10.5339/connect.2024.spt.1
2024-01-31
2024-07-16
Loading full text...

Full text loading...

/deliver/fulltext/connect/2024/1/connect.2024.spt.1.html?itemId=/content/journals/10.5339/connect.2024.spt.1&mimeType=html&fmt=ahah

References

  1. Justison G. Is timing everything? The Journal of Extra-Corporeal Technology. 2017; 49:(2):P13–P18. https://pubmed.ncbi.nlm.nih.gov/28638165/
    [Google Scholar]
  2. Dijoy L, Dean JS, Bistrick C, Sistino JJ. The history of goal-directed therapy and relevance to cardiopulmonary bypass. The Journal of Extra-Corporeal Technology. 2015; 47:(2):90–94. )https://pubmed.ncbi.nlm.nih.gov/26405356/
    [Google Scholar]
  3. Ranucci M, Johnson I, Willcox T, Baker RA, Boer C, Baumann A et al. Goal-directed perfusion to reduce acute kidney injury: A randomized trial.The Journal of Thoracic and Cardiovascular Surgery. 2018; 156:(5):1918–1927.
    [Google Scholar]
  4. Ranucci M, Romitti F, Isgrò G, Cotza M, Brozzi S, Boncilli A et al. Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations. The Annals of Thoracic Surgery. 2005; 80:(6):2213–2220.
    [Google Scholar]
  5. Baker RA, Bronson SL, Dickinson TA, Fitzgerald DC, Likosky DS, Mellas NB et al. Report from AmSECT’s International Consortium for Evidence-Based Perfusion: American Society of Extracorporeal Technology Standards and Guidelines for Perfusion Practice: 2013. The Journal of Extra-Corporeal Technology. 2013; 45:(3):156–166. https://pubmed.ncbi.nlm.nih.gov/24303597/
    [Google Scholar]
  6. Srey R, Rance G, Shapeton AD, Leissner KB, Zenati MA. A quick reference tool for goal-directed perfusion in cardiac surgery. The Journal of Extra-Corporeal Technology. 2019; 51:(3):172–174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749167/
    [Google Scholar]
  7. Mongero LB, Beck JR. On bypass: Advanced perfusion techniques. New York: Springer Science & Business Media; 2009.
  8. Rasmussen SR, Kandler K, Nielsen RV, Cornelius Jakobsen P, Knudsen NN, Ranucci M et al. Duration of critically low oxygen delivery is associated with acute kidney injury after cardiac surgery. Acta Anaesthesiologica Scandinavica. 2019; 63:(10):1290–1297.
    [Google Scholar]
  9. Gordon Betts J, Young KA, Wise JA, Johnson E, Poe B, Kruse DH et al. Anatomy and physiology. OpenStax; 2013. https://openstax.org/details/books/anatomy-and-physiology
    [Google Scholar]
  10. Pagano D, Milojevic M, Meesters MI, Benedetto U, Bolliger D, von Heymann C et al.2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. European Journal of Cardio-Thoracic Surgery. 2018; 53:(1):79–111.
    [Google Scholar]
  11. Parolari A, Alamanni F, Gherli T, Bertera A, Dainese L, Costa C et al. Cardiopulmonary bypass and oxygen consumption: Oxygen delivery and hemodynamics. The Annals of Thoracic Surgery. 1999; 67:(5):1320–1327.
    [Google Scholar]
  12. de Somer F, Mulholland JW, Bryan MR, Aloisio T, Van Nooten GJ, Ranucci M. O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: Time for a goal-directed perfusion management? Critical Care. 2011; 15:(4):R192.
    [Google Scholar]
  13. Magruder JT, Crawford TC, Harness HL, Grimm JC, Suarez-Pierre A, Wierschke C et al. A pilot goal-directed perfusion initiative is associated with less acute kidney injury after cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery. 2017; 153:(1):118–125.
    [Google Scholar]
  14. Baker RA. Variation in measurement and reporting of goal directed perfusion parameters. The Journal of Extra-Corporeal Technology. 2017; 49:(2):P2–P7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474899//
    [Google Scholar]
  15. de Somer F. End-organ protection in cardiac surgery.Minerva Anestesiologica. 2012; 79:(3):285–293. https://pubmed.ncbi.nlm.nih.gov/23174917/
    [Google Scholar]
  16. Anastasiadis K, Murkin J, Antonitsis P, Bauer A, Ranucci M, Gygax E et al. Use of minimal invasive extracorporeal circulation in cardiac surgery: Principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS). Interactive Cardiovascular and Thoracic Surgery. 2016; 22:(5):647–662.
    [Google Scholar]
  17. Ortega-Loubon C, Fernández-Molina M, Carrascal-Hinojal Y, Fulquet-Carreras E. Cardiac surgery-associated acute kidney injury. Annals of Cardiac Anaesthesia. 2016; 19:(4):687–698.
    [Google Scholar]
  18. O’Neal JB, Shaw AD, Billings FT Acute kidney injury following cardiac surgery: Current understanding and future directions. Critical Care. 2016; 20:(1):1–9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931708/
    [Google Scholar]
  19. Groom RC. Is it time for goal-directed therapy in perfusion. The Journal of Extra-Corporeal Technology. 2017; 49:(2):P8–P12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474901/
    [Google Scholar]
  20. Murphy GS, Hessel EA, Groom RC. Optimal perfusion during cardiopulmonary bypass: An evidence-based approach. Anesthesia & Analgesia. 2009; 108:(5):1394–1417.
    [Google Scholar]
  21. Stammers AH, Miller R, Francis SG, Fuzesi L, Nostro A, Tesdahl E. Goal-directed perfusion methodology for determining oxygenator performance during clinical cardiopulmonary bypass. The Journal of Extra-Corporeal Technology. 2017; 49:(2):81–92. https://pubmed.ncbi.nlm.nih.gov/28638156/
    [Google Scholar]
/content/journals/10.5339/connect.2024.spt.1
Loading
/content/journals/10.5339/connect.2024.spt.1
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error