Objectives: To assess current practice in adult cardiac surgery during cardiopulmonary
bypass (CPB) across European and non-European countries. Design: International, multicenter,
web-based survey including 28 multiple choice questions addressing hemodynamic and
tissue oxygenation parameters, organ protection measures, and the monitoring and usage
of anesthetic drugs as part of the anesthetic and perfusion practice during CPB. Setting:
Online survey endorsed by the European Association of Cardiothoracic Anesthesiologists.
Participants: Representatives of anesthesiology departments in European and non-European
adult cardiac surgical centers. Interventions: None. Measurements and Main Results:
The survey was distributed via e-mail to European Association of Cardiothoracic Anesthesiologists
members (n = 797) and kept open for 1 month. The response rate was 34% (n = 271).
After exclusion of responses from the same centers and of incomplete answers, data
from 202 cardiac centers in 56 countries, of which 67% of centers were university
hospitals, were analyzed. Optimization of pump flows and tissue oxygenation parameters
during CPB were applied by the majority of centers, with target flow rates of >2.2
L/min/m(2) in 93% (n = 187) of centers and mean arterial blood pressures between 51
and 90 mmHg in 85% (n = 172). Hemoglobin transfusion triggers were either individualized
or between 7 and 8 g/dL in 92% (n = 186) of centers. Mixed venous oxyhemoglobin saturations
were assessed routinely in 59% (n = 120) and lactate in 88% (n = 178) of cardiac surgery
units. Noninvasive cerebral saturation monitoring was used in a subgroup of patients
or routinely in 84% (n = 169) of sites, and depth-of-anesthesia monitoring was used
routinely in 53% (n = 106). Transesophageal echocardiography and pulmonary artery
catheters were used routinely or in subgroups of patients in 97% (n = 195) and 71%
(n = 153) of centers, respectively. The preferred site for temperature monitoring
was the nasopharynx in 66% (n = 134) of centers. Anesthetic techniques were variable,
with 26% of centers (n = 52) using low-tidal-volume ventilation and 28% (n = 57) using
continuous positive airway pressure during CPB. Volatile agents were used routinely
as the only agent during CPB in 36% sites (n = 73) and propofol in 47% (n = 95). Other
drugs routinely administered included magnesium in 45% (n = 91), steroids in 18% (n
= 37), tranexamic acid in 88% (n = 177), and aprotinin in 15% (n = 30) of the centers.
Conclusion: This international CPB survey revealed that techniques for optimization
of pump flow and oxygenation during CPB usually were applied. Furthermore, cerebral
and hemodynamic monitoring devices were frequently used during CPB. However, most
CPB-related anesthetic techniques and medications were more variable. More high-quality
randomized controlled trials are needed to assess anesthetic techniques and organ
protection. (C) 2020 Published by Elsevier Inc.
