Thoughts and Progress Variations in the Application of Various Perfusion Technologies in Great Britain and Ireland—A National Survey Oliver J. Warren, Sophie Wallace, Katie L. de Wit, Charles Vincent, Ara W. Darzi, and Thanos Athanasiou Department of BioSurgery and Surgical Technology, Imperial College London, London, UK Abstract: In an attempt to reduce the negative sequelae of cardiopulmonary bypass (CPB), a variety of new technolo- gies have been created. This study investigates variations in the application of these technologies throughout Great Britain and Ireland (GB & I). All perfusion departments within GB & I were surveyed about equipment and tech- nologies used in CPB. Eighty-five percent of units use a standard arterial line filter in all cases. Forty percent of units occasionally use leukocyte-depleting filters in various sites within the circuit. Sixteen percent always use some element of heparin-bonded circuit, but 62% never use them.Twenty-five percent use solely rotary pumps, 18% use solely centrifugal pumps, and 56% use both. Finally, 20% are now using minimal extracorporeal circulation in certain clinical scenarios. These decisions are most frequently affected by clinician preference and cost. This survey has highlighted significant variation in the utilization of various technologies used in CPB. While some variation between centers is to be expected, as innovative technologies are adopted at varying rates, surveys such as this are useful for alerting clinicians to gaps between evidence-based knowledge and clinical practice. Key Words: Cardiac— Cardiopulmonary bypass—Inflammation—Perfusion— Surgery. Cardiopulmonary bypass (CPB) is used in approxi- mately 35 000 adult and 1000 pediatric cardiac surgi- cal procedures in the UK each year (data not available for the Republic of Ireland) (1,2). CPB is known to contribute to an undesirable systemic inflammatory response syndrome witnessed after cardiac surgery; in most circumstances, the resulting organ dysfunction is transient and self-terminating because the homeostatic defense mechanisms are able to compensate, but on occasions, patients may experience major morbidity leading to increased intensive care unit and hospital length of stay, or even death. In an attempt to reduce the negative impact of CPB, a variety of therapeutic interventions have been studied. Some of these are pharmaceutical, but a significant number are new technologies and equipment. While these innovations are described and discussed in the medical literature, surveys carried out within North America, Canada, Australa- sia, and France demonstrate that the extent to which they have been adopted into CPB clinical practice varies (3–8). No such survey to investigate practice in Great Britain and Ireland (GB & I) has been previ- ously performed. The aim of this study was to use a questionnaire survey to investigate variations in the clinical practice of CPB throughout GB & I, focusing on the applica- tion of technical strategies to attenuate the inflam- matory response to CPB. MATERIALS AND METHODS An updated list of cardiothoracic surgical units within GB & I was compiled from the hospital direc- tory held by the Society of Clinical Perfusion Scientists of Great Britain and Ireland (SCPSGBI) (accessed at http://www.scps.org.uk/index.php?option =com_content&task=view&id=50&Itemid=53). The aim was to collect data from every center listed. A questionnaire was drafted and tested on the three full-time perfusion staff at our own institution. Following this process, one question was added pertaining to the use of standard arterial line filters, and some minor alterations of wording and layout were performed. The survey consisted of six questions pertaining to demographics, equipment, techniques, and technologies. All questions allowed respondents to extrapolate and explain their answers and respondents were encouraged to do so, particularly where technologies were used only under certain circumstances. It was requested that only one person from any single institution com- plete the survey. The survey was completed in one of two ways. First, at the Annual Congress of the SCPSGBI doi:10.1111/j.1525-1594.2009.00857.x Received October 2008. Address correspondence and reprint requests to Mr. Oliver Warren MRCS (Eng), Department of BioSurgery and Surgical Technology, Imperial College London, 10th Floor QEQM Build- ing, St. Mary’s Hospital, London W2 1NY, UK. E-mail: o.warren@ imperial.ac.uk Artificial Organs 34(3):200–241, Wiley Periodicals, Inc. © 2010, Copyright the Authors Journal compilation © 2010, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. 200