J Extra Corpor Technol
Volume 50, Number 1, March 2018
|Page(s)||5 - 18|
|Published online||15 March 2018|
STS/SCA/AmSECT Clinical Practice Guidelines: Anticoagulation during Cardiopulmonary Bypass
* Department of Anesthesiology, Hofstra Northwell School of Medicine, New Hyde Park, New York;
† Cardiac Surgery Research and Perfusion, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia;
‡ Division of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, Kentucky;
§ Department of Anesthesiology & Pain Management, University of Texas-Southwestern Medical Center, Dallas, Texas;
¶ Division of Cardiovascular Perfusion, Medical University of South Carolina, Charleston, South Carolina;
‖ Department of Anesthesiology, Saint Anthony Hospital, Lakewood, Colorado; and
# Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Address correspondence to: Linda Shore-Lesserson, MD, Department of Anesthesiology, Hofstra Northwell School of Medicine at Hofstra University, 300 Community Drive, Manhasset, NY 11030. E-mail: email@example.com
Accepted: 2 November 2017
Despite more than a half century of “safe” cardiopulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, the Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), and the American Society of Extracorporeal Technology (AmSECT) developed an Evidence Based Workgroup. This was a group of interdisciplinary professionals gathered together to summarize the evidence and create practice recommendations for various aspects of CPB. To date, anticoagulation practices in CPB have not been standardized in accordance with the evidence base. This clinical practice guideline was written with the intent to fill the evidence gap and to establish best practices in anticoagulation for CPB using the available evidence. To identify relevant evidence a systematic review was outlined and literature searches were conducted in PubMed® using standardized MeSH terms from the National Library of Medicine list of search terms. Search dates were inclusive of January 2000 to December 2015. The search yielded 833 abstracts which were reviewed by two independent reviewers. Once accepted into the full manuscript review stage, two members of the writing group evaluated each of 286 full papers for inclusion eligibility into the guideline document. Ninety-six manuscripts were included in the final review. In addition, 17 manuscripts published prior to 2000 were included to provide method, context, or additional supporting evidence for the recommendations as these papers were considered sentinel publications. Members of the writing group wrote and developed recommendations based on review of the articles obtained and achieved more than two thirds agreement on each recommendation. The quality of information for a given recommendation allowed assessment of the level of evidence as recommended by the AHA/ACCF Task Force on Practice Guidelines. Recommendations were written in the three following areas 1) Heparin dosing and monitoring for initiation and maintenance of CPB, 2) Heparin contraindications and heparin alternatives, 3) Reversal of anticoagulation during cardiac operations. It is hoped that this guideline will serve as a resource and will stimulate investigators to conduct more research and expand upon the evidence base on the topic of anticoagulation for CPB.
Key words: cardiopulmonary bypass / heparin / heparin alternatives / protamine / anticoagulation reversal / bivalirudin
© 2018 AMSECT
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