2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery
Introduction
1.1 Background
The current document presents a revision of the 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery, emerging from a collaborative effort among the EBCP, EACTAIC and EACTS to establish guidance for unified clinical practice guidelines (CPB) practice [1, 2]. The previous guidelines provided the first comprehensive European guidance based on evidence, promoting a message of excellence through collaboration within the cardiac surgical, perfusion and anaesthetic communities.
With recent advances in research that unveiled new evidence related to CPB, an update to the 2019 guidelines was necessary. The revised guidelines reaffirm the foundational practices and incorporate new recommendations that align with the latest evidence-based medicine and contemporary European clinical practices. They expand the guideline’s scope with additional sections addressing crucial topics such as temperature management and deep hypothermic circulatory arrest (DHCA). However, the necessity for further research persists, and this iteration of the guidelines emphasizes the ongoing need for scientific inquiry and trials in various CPB domains.
Whereas recent international guidelines cover specific topics like patient blood management and perioperative medication, this document summarizes the evidence and directs readers to these comprehensive guidelines for further details [3, 4]. The task force acknowledges that there have been no significant updates related to CPB, and thus refers to existing materials. Due to length constraints, paediatric CPB has not been included in this edition. These guidelines concentrate on perfusion-related recommendations in addressing broad topics such as cardioplegia and minimally invasive surgery.
1.2 What is new
The updated CPB guidelines have undergone a comprehensive review to enhance their clinical applicability and to incorporate the latest evidence since the 2019 edition. Significant additions include new sections that broaden the scope of the guidelines:
- Section 5.8 focuses on tubing, specifically addressing the use of plasticizers in tubing materials.
- Section 6 on monitoring now includes recommendations on neuromonitoring as well as haemodynamic monitoring and management.
- Section 7, Organ protection, compiles evidence on strategies to protect organs during CPB.
- A new section, 9.10, on blood purification, has been introduced.
- Section 10 discusses CPB for specific techniques, focusing on perfusion strategies for aortic and aortic arch operations.
- Lastly, Section 12 addresses specific situations during CPB, tackling the management of adverse events.
The goal of these additions is to provide comprehensive coverage of the most current and relevant aspects of CPB, ensuring that the guidelines remain a valuable resource for clinicians in adult cardiac surgery.