2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

Introduction

The invention of CPB revolutionized cardiac surgery. This vital tool has been continuously refined over the years. Today, achieving excellent results depends on a team approach and the expertise of dedicated perfusionists. Apart from learning the skills necessary to conduct CPB, perfusionists also learn about the science behind modern CPB. Therefore, the present document particularly aims at summarizing the scientific basis for the various aspects of the CPB technique. In addition to previous guidelines and statements, which have given excellent advice on how modern CPB should be performed, these guidelines contain specific recommendations reflecting a European expert consensus. Furthermore, the document contains a chapter dedicated to the training, education and service delivery from the European perspective.

Good quality research has been conducted in several areas of perfusion, such as the use of minimized circuits. However, we found a lack of scientific investigations and clinical trials in many other fields. These CPB guidelines point out the areas where further research is required, with the hope of stimulating future investigations. These guidelines are the result of a collaborative effort by the EBCP, the EACTA and the EACTS, aiming to document a broad consensus of all parties involved in CPB. At the same time, these CPB guidelines are the first evidence-based European document that offers a comprehensive overview of all the issues that are related to modern CPB practice.

Some specific topics, such as patient blood management, have been covered by recent international guidelines. Therefore, the evidence is in part summarized in these guidelines and readers are referred to the respective guidelines [2] because the task force has not identified a need for any major update related to CPB. This approach is also true for hypothermia and temperature management during CPB [3]. The topic of deep hypothermic circulatory arrest is multifactorial and complex and will be covered in a separate document. Paediatric aspects of CPB could not be included in this document due to the given restrictions in its length. When covering broad topics, such as cardioplegia and minimally invasive surgery, the recommendations in these guidelines are focused on perfusion aspects.