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J Thorac Cardiovasc Surg 2002;124:20-27
© 2002 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology (CSP) |
Written on behalf of the Working Group on Extracorporeal Circulation and Mechanical Ventricular Assist Devices of the German Society for Thoracic and Cardiovascular Surgery.
Received for publication March 9, 2001. Revisions requested May 31, 2001; revisions received Sept 12, 2001. Accepted for publication Oct 1, 2001. Address for reprints: C. Bartels, MD, Clinic for Cardiac Surgery, Medical University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
Objective: Evidence-based medicine is emerging as a new paradigm for medical practice. The purpose of this study was to evaluate the amount and quality of scientific evidence supporting principles that are currently applied for cardiopulmonary bypass performance.
Methods: A survey of all German departments of cardiac surgery regarding cardiopulmonary bypass performance disclosed major differences. Consequently, for 48 major principles of cardiopulmonary bypass performance, relevant Medical Subject Headings were identified, and a literature search of the Medline database was performed. Two sequentially applied sets of inclusion-exclusion criteria were selected to assess the best available evidence.
Results: Thirty-three thousand articles relating to the subject were identified. Among these, 1500 fulfilled the first set of inclusion criteria: meta-analysis of (randomized) controlled clinical trials and in vitro and animal studies. Rigorous methodological criteria were then applied to further select remaining publications. Ultimately, 225 articles referring to major cardiopulmonary bypass principles were identified as providing the best available evidence. These were graded according to their methodological rigor (susceptibility to bias). The scientific evidence on the investigated cardiopulmonary bypass principles did not prove to be of a high enough level to allow general recommendations to be made.
Conclusions: The scientific data concerning the effectiveness and safety of key principles of cardiopulmonary bypass are insufficient in both amount and quality of scientific evidence to serve as a basis for practical, evidence-based guidelines.
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J. Thorac. Cardiovasc. Surg. 2002 124: 11-13.
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