Pump Priming Practices and Anticoagulation in Cardiac Surgery: Results From the Global Cardiopulmonary Bypass Survey.

Abstract

Regional patterns of practice in cardiopulmonary bypass remain poorly understood with conflicting evidence regarding the best choices in pump priming preferences with respect to colloid and crystalloid and different types of fluid within these categories. In light of the variation in the literature, we hypothesized there would be considerable regional differences in cardiopulmonary bypass practice, particularly with respect to the type of fluid used to prime the extracorporeal circuit. A 16-question, Internet-based survey was distributed by various regional specialist societies, targeting adult cardiac anesthesiologists. One question was directly relevant to activated clotting time and 5 concerned pump priming choices with respect to crystalloid and colloid types and additives. The remaining questions concerned cardioplegia choices. The survey remained open from June 2015 to May 2016. A total of 923 responses were analyzed. Estimated response rates from Europe, North America, Australia/New Zealand, and South America were 19.77%, 8.06%, 16.30%, and 1.68%, respectively. The majority of respondents worldwide considered an activated clotting time of <400 seconds as unsafe for bypass (92.5%). Crystalloid as a sole fluid type remains the most common priming solution worldwide (38.1%) although combinations with colloid (23.8%) were also popular. Retrograde autologous priming was used by 17.9% of respondents. Heparin was the most frequently used prime additive (43.0%) followed by mannitol (35.2%). Variation was demonstrated within some of these categories reflective of differences in regional practices. Differences exist in some specific areas between regional cardiopulmonary bypass techniques with respect to pump priming and anticoagulation practices. The significance of these differences with respect to patient outcome is uncertain and requires further study.