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A Survey of Practices during Cardiopulmonary Bypass in India: An Indian Association of Cardiovascular and Thoracic Anesthesiologist Endeavor

CONTEXT: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. AIMS: The aim of this survey is to gather information on variations during the conduct of CPB in India. SETT...

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Autores principales: Borde, Deepak Prakash, Joshi, Shreedhar S., Chakravarthy, Murali, Malik, Vishwas, Karthekeyan, Ranjith B., George, Antony, Koshy, Thomas, Gandhe, Uday, Nair, Suresh G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350424/
https://www.ncbi.nlm.nih.gov/pubmed/30648681
http://dx.doi.org/10.4103/aca.ACA_67_18
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author Borde, Deepak Prakash
Joshi, Shreedhar S.
Chakravarthy, Murali
Malik, Vishwas
Karthekeyan, Ranjith B.
George, Antony
Koshy, Thomas
Gandhe, Uday
Nair, Suresh G.
author_facet Borde, Deepak Prakash
Joshi, Shreedhar S.
Chakravarthy, Murali
Malik, Vishwas
Karthekeyan, Ranjith B.
George, Antony
Koshy, Thomas
Gandhe, Uday
Nair, Suresh G.
author_sort Borde, Deepak Prakash
collection PubMed
description CONTEXT: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. AIMS: The aim of this survey is to gather information on variations during the conduct of CPB in India. SETTINGS AND DESIGN: This was an online conducted survey by Indian College of Cardiac Anaesthesia, which is the research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. SUBJECTS AND METHODS: Senior consultants heading cardiac anesthesia departments in both teaching and nonteaching centers (performing at least 15 cases a month) were contacted using an online questionnaire fielded using SurveyMonkey™ software. There were 33 questions focusing on institute information, perfusion practices, blood conservation on CPB; monitoring and anesthesia practices. RESULTS: The response rate was 74.2% (187/252). Fifty-one (26%) centers were teaching centers; 18% centers performed more than 1000 cases annually. Crystalloid solution was the most common priming solution used. Twenty-three percent centers used corticosteroids routinely; methylprednisone was the most commonly used agent. The cardioplegia solution used by most responders was the one available commercially containing high potassium St. Thomas solution (55%), followed by Del Nido cardioplegia (33%). Majority of the responders used nasopharyngeal site to monitor intraoperative patient temperature. Antifibrinolytics were commonly used only in patients who were at high risk for bleeding by 51% of responders, while yet, another 39% used them routinely, and 11% never did. About 59% of the centers insist on only fresh blood (<7 days old) when blood transfusion was indicated. The facility to use vaporizer on CPB was available in 62% of the centers. All the teaching centers or high volume centers in India had access to transesophageal echocardiography probe and echo machine, with 51% using them routinely and 38% using them at least sometimes. CONCLUSIONS: There is a wide heterogeneity in CPB management protocols among various Indian cardiac surgery centers. The survey suggests that adherence to evidence-based and internationally accepted practices appears to be more prevalent in centers that have ongoing teaching programs and/or have high volumes, strengthening the need to devise guidelines by appropriate body to help bring in uniformity in CPB management to ensure patient safety and high quality of clinical care for best outcomes.
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spelling pubmed-63504242019-03-08 A Survey of Practices during Cardiopulmonary Bypass in India: An Indian Association of Cardiovascular and Thoracic Anesthesiologist Endeavor Borde, Deepak Prakash Joshi, Shreedhar S. Chakravarthy, Murali Malik, Vishwas Karthekeyan, Ranjith B. George, Antony Koshy, Thomas Gandhe, Uday Nair, Suresh G. Ann Card Anaesth Original Article CONTEXT: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. AIMS: The aim of this survey is to gather information on variations during the conduct of CPB in India. SETTINGS AND DESIGN: This was an online conducted survey by Indian College of Cardiac Anaesthesia, which is the research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. SUBJECTS AND METHODS: Senior consultants heading cardiac anesthesia departments in both teaching and nonteaching centers (performing at least 15 cases a month) were contacted using an online questionnaire fielded using SurveyMonkey™ software. There were 33 questions focusing on institute information, perfusion practices, blood conservation on CPB; monitoring and anesthesia practices. RESULTS: The response rate was 74.2% (187/252). Fifty-one (26%) centers were teaching centers; 18% centers performed more than 1000 cases annually. Crystalloid solution was the most common priming solution used. Twenty-three percent centers used corticosteroids routinely; methylprednisone was the most commonly used agent. The cardioplegia solution used by most responders was the one available commercially containing high potassium St. Thomas solution (55%), followed by Del Nido cardioplegia (33%). Majority of the responders used nasopharyngeal site to monitor intraoperative patient temperature. Antifibrinolytics were commonly used only in patients who were at high risk for bleeding by 51% of responders, while yet, another 39% used them routinely, and 11% never did. About 59% of the centers insist on only fresh blood (<7 days old) when blood transfusion was indicated. The facility to use vaporizer on CPB was available in 62% of the centers. All the teaching centers or high volume centers in India had access to transesophageal echocardiography probe and echo machine, with 51% using them routinely and 38% using them at least sometimes. CONCLUSIONS: There is a wide heterogeneity in CPB management protocols among various Indian cardiac surgery centers. The survey suggests that adherence to evidence-based and internationally accepted practices appears to be more prevalent in centers that have ongoing teaching programs and/or have high volumes, strengthening the need to devise guidelines by appropriate body to help bring in uniformity in CPB management to ensure patient safety and high quality of clinical care for best outcomes. Medknow Publications & Media Pvt Ltd 2019 /pmc/articles/PMC6350424/ /pubmed/30648681 http://dx.doi.org/10.4103/aca.ACA_67_18 Text en Copyright: © 2019 Annals of Cardiac Anaesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Borde, Deepak Prakash
Joshi, Shreedhar S.
Chakravarthy, Murali
Malik, Vishwas
Karthekeyan, Ranjith B.
George, Antony
Koshy, Thomas
Gandhe, Uday
Nair, Suresh G.
A Survey of Practices during Cardiopulmonary Bypass in India: An Indian Association of Cardiovascular and Thoracic Anesthesiologist Endeavor
title A Survey of Practices during Cardiopulmonary Bypass in India: An Indian Association of Cardiovascular and Thoracic Anesthesiologist Endeavor
title_full A Survey of Practices during Cardiopulmonary Bypass in India: An Indian Association of Cardiovascular and Thoracic Anesthesiologist Endeavor
title_fullStr A Survey of Practices during Cardiopulmonary Bypass in India: An Indian Association of Cardiovascular and Thoracic Anesthesiologist Endeavor
title_full_unstemmed A Survey of Practices during Cardiopulmonary Bypass in India: An Indian Association of Cardiovascular and Thoracic Anesthesiologist Endeavor
title_short A Survey of Practices during Cardiopulmonary Bypass in India: An Indian Association of Cardiovascular and Thoracic Anesthesiologist Endeavor
title_sort survey of practices during cardiopulmonary bypass in india: an indian association of cardiovascular and thoracic anesthesiologist endeavor
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350424/
https://www.ncbi.nlm.nih.gov/pubmed/30648681
http://dx.doi.org/10.4103/aca.ACA_67_18
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