Guidelines for Conduct of Cardiopulmonary Bypass

The recently published 2019 European Association for Cardio-Thoracic Surgery (ECTS)/European Association for Cardiothoracic Anaesthesiology (EACTA)/European Board for Cardiovascular Perfusion guideline on CPB in adult cardiac surgery, is a timely, well-informed collaborative document that includes an exhaustive structured review of the related literature, and where evidence is lacking, expert consensus from all 3 disciplines is provided.

To promote wide dissemination, the guideline was copublished with permission in the British Journal of Anaesthesia, the European Journal of Cardio-Thoracic Surgery, and the Interactive CardioVascular and Thoracic Surgery journal. Many of our colleagues in North America took notice of this work and are reading it with great interest. The authors of the guidelines are a multidisciplinary, world class group comprising European surgeons, anesthesiologists, perfusionists, and an epidemiologist. The guideline was written following the EACTS practice guideline writing instructions. This methodology was modeled after the handbook for guideline writing by the American College of Cardiology (ACC) and American Heart Association (AHA). It is important to note that the EACTS framework uses slightly different definitions for the levels of evidence and classification. Some of the more important differences between the ACC/AHA and EACTS classifications were pointed out by Baker et al. in their recent editorial.

However in both cases, the stated aim is to provide well-balanced, objective, and unbiased multidisciplinary recommendations that will be embraced by clinicians and encourage decision- making that endorses patient care on the basis of the best available science and expert opinion. Another benefit of this work is that it identifies areas for which currently there is low evidence and that may perhaps attract future investigation.