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Wahba A, Kunst G, De Somer F, Kildahl HA, Milne B, Kjellberg G, Bauer A, Beyersdorf F, Ravn HB, Debeuckelaere G, Erdoes G, Haumann RG, Gudbjartsson T, Merkle F, Pacini D, Paternoster G, Onorati F, Ranucci M, Ristic N, Vives M, Milojevic M. 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery. Br J Anaesth 2025; 134:917-1008. [PMID: 39955230 PMCID: PMC11947607 DOI: 10.1016/j.bja.2025.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2025] Open
Abstract
Clinical practice guidelines consolidate and evaluate all pertinent evidence on a specific topic available at the time of their formulation. The goal is to assist physicians in determining the most effective management strategies for patients with a particular condition. These guidelines assess the impact on patient outcomes and weigh the risk-benefit ratio of various diagnostic or therapeutic approaches. While not a replacement for textbooks, they provide supplementary information on topics relevant to current clinical practice and become an essential tool to support the decisions made by specialists in daily practice. Nonetheless, it is crucial to understand that these recommendations are intended to guide, not dictate, clinical practice, and should be adapted to each patient's unique needs. Clinical situations vary, presenting a diverse array of variables and circumstances. Thus, the guidelines are meant to inform, not replace, the clinical judgement of healthcare professionals, grounded in their professional knowledge, experience and comprehension of each patient's specific context. Moreover, these guidelines are not considered legally binding; the legal duties of healthcare professionals are defined by prevailing laws and regulations, and adherence to these guidelines does not modify such responsibilities. The European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) and the European Board of Cardiovascular Perfusion (EBCP) constituted a task force of professionals specializing in cardiopulmonary bypass (CPB) management. To ensure transparency and integrity, all task force members involved in the development and review of these guidelines submitted conflict of interest declarations, which were compiled into a single document available on the EACTS website (https://www.eacts.org/resources/clinical-guidelines). Any alterations to these declarations during the development process were promptly reported to the EACTS, EACTAIC and EBCP. Funding for this task force was provided exclusively by the EACTS, EACTAIC and EBCP, without involvement from the healthcare industry or other entities. Following this collaborative endeavour, the governing bodies of EACTS, EACTAIC and EBCP oversaw the formulation, refinement, and endorsement of these extensively revised guidelines. An external panel of experts thoroughly reviewed the initial draft, and their input guided subsequent amendments. After this detailed revision process, the final document was ratified by all task force experts and the leadership of the EACTS, EACTAIC and EBCP, enabling its publication in the European Journal of Cardio-Thoracic Surgery, the British Journal of Anaesthesia and Interdisciplinary CardioVascular and Thoracic Surgery. Endorsed by the EACTS, EACTAIC and EBCP, these guidelines represent the official standpoint on this subject. They demonstrate a dedication to continual enhancement, with routine updates planned to ensure that the guidelines remain current and valuable in the ever-progressing arena of clinical practice.
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Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Therapy King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, United Kingdom.
| | | | - Henrik Agerup Kildahl
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Benjamin Milne
- Department of Anaesthesia, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gunilla Kjellberg
- Department of Thoracic Surgery and Anaesthesiology, Uppsala University Hospital, Uppsala, Sweden
| | - Adrian Bauer
- Department of Perfusiology, Evangelic Heart Center, Coswig, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Germany; Medical Faculty of the Albert-Ludwigs-University Freiburg, Germany
| | - Hanne Berg Ravn
- Department of Anaesthesia, Odense University Hospital and Institute of Clinical Medicine, Southern Denmark University, Denmark
| | | | - Gabor Erdoes
- University Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Renard Gerhardus Haumann
- Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Frank Merkle
- Foundation Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; University of Bologna, Bologna, Italy
| | - Gianluca Paternoster
- Cardiovascular Anesthesia and Intensive Care San Carlo Hospital, Potenza, Italy; Department of Health Science Anesthesia and ICU School of Medicine, University of Basilicata San Carlo Hospital, Potenza, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Nemanja Ristic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Marc Vives
- Department of Anesthesia & Critical Care, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
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Wahba A, Kunst G, De Somer F, Agerup Kildahl H, Milne B, Kjellberg G, Bauer A, Beyersdorf F, Berg Ravn H, Debeuckelaere G, Erdoes G, Haumann RG, Gudbjartsson T, Merkle F, Pacini D, Paternoster G, Onorati F, Ranucci M, Ristic N, Vives M, Milojevic M. 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg 2025; 67:ezae354. [PMID: 39949326 PMCID: PMC11826095 DOI: 10.1093/ejcts/ezae354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/01/2024] [Indexed: 02/17/2025] Open
Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Therapy King’s College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Excellence, London, United Kingdom
| | | | - Henrik Agerup Kildahl
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Benjamin Milne
- Department of Anaesthesia, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Gunilla Kjellberg
- Department of Thoracic Surgery and Anaesthesiology, Uppsala University Hospital, Uppsala, Sweden
| | - Adrian Bauer
- Department of Perfusiology, Evangelic Heart Center, Coswig, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Germany
- Medical Faculty of the Albert-Ludwigs-University Freiburg, Germany
| | - Hanne Berg Ravn
- Department of Anaesthesia, Odense University Hospital and Institute of Clinical Medicine, Southern Denmark University, Denmark
| | | | - Gabor Erdoes
- University Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Renard Gerhardus Haumann
- Department of Cardio-Thoracic surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
- Department Of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Frank Merkle
- Foundation Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- University of Bologna, Bologna, Italy
| | - Gianluca Paternoster
- Cardiovascular Anesthesia and Intensive Care San Carlo Hospital, Potenza, Italy
- Department of Health Science Anesthesia and ICU School of Medicine, University of Basilicata San Carlo Hospital, Potenza, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Nemanja Ristic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Marc Vives
- Department of Anesthesia & Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
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Tokaji M, Ninomiya S, Kurosaki T, Orihashi K, Sueda T. An educational training simulator for advanced perfusion techniques using a high-fidelity virtual patient model. Artif Organs 2012; 36:1026-35. [PMID: 22963152 DOI: 10.1111/j.1525-1594.2012.01512.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The operation of cardiopulmonary bypass procedure requires an advanced skill in both physiological and mechanical knowledge. We developed a virtual patient simulator system using a numerical cardiovascular regulation model to manage perfusion crisis. This article evaluates the ability of the new simulator to prevent perfusion crisis. It combined short-term baroreflex regulation of venous capacity, vascular resistance, heart rate, time-varying elastance of the heart, and plasma-refilling with a simple lumped parameter model of the cardiovascular system. The combination of parameters related to baroreflex regulation was calculated using clinical hemodynamic data. We examined the effect of differences in autonomous-nerve control parameter settings on changes in blood volume and hemodynamic parameters and determined the influence of the model on operation of the control arterial line flow and blood volume during the initiation and weaning from cardiopulmonary bypass. Typical blood pressure (BP) changes (hypertension, stable, and hypotension) were reproducible using a combination of four control parameters that can be estimated from changes in patient physiology, BP, and blood volume. This simulation model is a useful educational tool to learn the recognition and management skills of extracorporeal circulation. Identification method for control parameter can be applied for diagnosis of heart failure.
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Affiliation(s)
- Megumi Tokaji
- Department of Surgery, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
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Momose N, Tomizawa Y. Incident-simulating device with wireless control for extracorporeal circulation crisis management drills. Perfusion 2008; 23:17-21. [PMID: 18788213 DOI: 10.1177/0267659108093874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Incidents during extracorporeal circulation (ECC) may lead to serious consequences, and troubleshooting exercises are becoming more important. We developed an incident-simulation device operated by remote control for ECC crisis management drills, and evaluated its efficacy at a seminar for perfusionists. This compact device consists of a transmitter and a receiving system and is run by dry batteries without a personal computer. A 4-channel radio-control system is used as the transmitter, and four servomotors placed in a box as the receiving system. To simulate occlusion of 3/8" arterial and venous lines, two servomotors with a rod rotate and the rod compresses the tube. The tilt angle of the stick and the servomotor rotation are in proportion, so that the degree of occlusion is controlled. As a result, the tube lumen becomes "stenotic" and then occluded, depending on the rotation. To cut off the power, the other two servomotors, with a relay system, work as a breaker. When the rod of the servomotor rotates, a micro-switch is turned off. The present device is able to increase perfusion pressure quickly and to simulate inadequate venous drainage quietly. At a seminar for perfusionists, an instructor manipulated the transmitter to create incidents and the participants handled the events effectively. In conclusion, incidents created by this device were perceived as similar to real ECC crises and this device may be useful and educationally effective when used in crisis management drills for perfusionists and trainees.
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Affiliation(s)
- N Momose
- Department of Medical Engineering, Saitama Medical Center, Jichi Medical School, Saitama, Japan
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