Article

International Survey of Perfusion Practice for Pediatric and Congenital Heart Surgery: 2021 Results

^* The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio;
^† Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;
^‡ Boston Children’s Hospital, Boston, Massachusetts;
^§ Department of Business Process Improvement at Nationwide Children’s Hospital, Columbus, Ohio;
^ǁ All India Institute of Medical Sciences, New Delhi, India;
^¶ A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow;
^** Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; and
^†† Cardiovascular Surgery, Tenwek Mission Hospital, Bomet, Kenya

Address correspondence to: Ashley B. Walczak MBA, CCP, FPP, Cardiothoracic Surgery, 700 Children’s Drive, Tower Building, Room 4111, Columbus, OH 43205. E-mail: ashley.walczak@nationwidechildrens.org

Received: 25 March 2022
Accepted: 12 September 2022

Abstract

The conduct of cardiopulmonary bypass in neonatal, infant, and pediatric patients continuously evolves as new devices and innovative techniques are introduced. Since 1989, periodic pediatric perfusion surveys have been conducted to ascertain practice patterns involving demographics, equipment, and perfusion techniques. The goal of this current project is to provide an updated perspective on international pediatric and congenital perfusion practice since the last survey conducted in 2016. In July 2021, a 100-question perfusion survey was distributed to 284 pediatric cardiac surgery centers using a secure web browser-based data application. Each center was given a unique survey hyperlink to ensure one response per institution and to monitor the response rate. Centers were given 1 month to complete the survey and electronic reminders were sent weekly to nonrespondents. After the survey was closed, information from completed surveys was exported to a software program for analysis. Responses were received from 153 of 284 pediatric centers for a response rate of 54%. Sixty respondents (39%) were from North American (NA) centers while 93 respondents (61%) were from non-North American (NNA) centers. The vast majority of centers use a roller head arterial pump (93%), hollow fiber oxygenators with open reservoirs (86%), and integrated arterial line filters (73%). The use of modified ultrafiltration was reported by 76% of centers. Ninety-two percent of centers reported the use of selective antegrade cerebral perfusion for aortic arch repairs. The N + 1 staffing model was most prevalent (52%), followed by two perfusionists per case (33%). Periodic surveys continue to be a useful modality in assessing regional variation in pediatric perfusion practice. This survey marked the first time the majority of responses came from non-North American institutions. Identifying these practice patterns may aid in the development of, and adherence to, regional standards and guidelines. This would foster the reduction of variation in practice and potentially improve patient safety.