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J Thorac Cardiovasc Surg 2006;132:283-290
© 2006 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology |
a Department of Cardiothoracic Surgery, Montefiore-Einstein Heart Center, Bronx, NY
b Departments of Surgery, Medicine, and Community and Family Medicine, Dartmouth Medical School, Hanover, NH
c Department of Anesthesiology and Perioperative Medicine, London Health Sciences Center, London, Ontario, Canada
d Cardiac Surgical Research Group, Flinders Medical Centre, South Australia, Australia
e Department of Cardiothoracic Surgery, Catholic Medical Center, Manchester, NH
f Fresenius Medical Care Extracorporeal Alliance, San Diego, Calif
g Christina Care Health System, Wilmington, Del
h Department of Anesthesiology, Duke Medical Center, Durham, NC
i Department of Perfusion Services, University of Connecticut Health Center, Farmington, Conn
j Beth Israel-Deaconess Medical Center, Boston, Mass
k Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
Received for publication December 12, 2005; revisions received January 10, 2006; accepted for publication March 13, 2006. * Address for reprints: Donald S. Likosky, PhD, Departments of Surgery and Community and Family Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756. (Email: donald.likosky@dartmouth.edu).
| The first 300 words of the full text of this article appear below. |
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Introduction |
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Cardiopulmonary bypass (CPB) can be used during cardiac surgery to oxygenate and subsequently recirculate blood that has been diverted from the heart and lungs. The practice of CPB has changed—and continues to change—dramatically since its advent in the 1950s. Although structured reviews of the evidence supporting the practice of cardiac surgery have been in the literature for more than a decade and continue to be refined in the wake of new and emerging evidence,
E1,E2
additional targeted reviews, focusing on issues such as minimizing the effect of the inflammatory response or minimizing neurologic injury, are warranted.
E3–E5
Previous attempts, by Edwards and colleagues
E6
and Bartels and associates,
E7
at synthesizing the evidence base to support the principles of CPB have selectively reviewed the cardiac surgery literature or focused on unique patient populations. Additionally, the development of these reviews has not involved all members of the clinical team, most notably the individuals tasked with operating the CPB circuit. This gap in knowledge is in stark contrast with the shared goal of the cardiac team, namely to improve the conduct of CPB to reduce the patient's risk of adverse outcomes caused by cardiac surgery.
Despite a preponderance of evidence supporting key principles of managing safe and effective CPB practice, wide variation in the use of technology and techniques for conducting CPB persists regionally and nationally.
E8,E9
Variations in practice have previously been shown to be associated with increased costs, lengths of stay, neurologic injury, and mortality.
1–3,E5,E10,E11
This variation might be attributed to clinical uncertainty or institutional or local practice standards. To reduce this unwanted practice variation, we must provide our clinical colleagues with critically evaluated and evidence-based review for conducting CPB.
What follows is an evidence-based review for conducting safe, patient-centered, and effective CPB practice. The authors have graded the level of evidence and classified the
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