The Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons Cardiac Anesthesia Database Collaboration.

Multi-institutional databases and registries have proliferated over the last decade in all specialties of medicine. They may be especially helpful in low-frequency/high-acuity fields such as pediatric and congenital heart diseases. The Society of Thoracic Surgeon's Congenital Heart Surgery Database (STSCHSD) is the largest single data set for the congenital heart disease population and includes contemporaneous data from over 120 programs in the United States (and several outside of the United States), capturing greater than 98% of the congenital cardiac surgical procedures in the United States. In 2010, the Congenital Cardiac Anesthesia Society partnered with the STSCHSD to incorporate anesthesia-related elements into the data set. Voluntary site participation in the anesthesia data has grown steadily. Currently, over 60 sites performing more than 60% of cardiac bypass procedures in the STSCHSD are submitting anesthesia data annually into the STSCHSD. Anesthesia data include perioperative medication usage, modalities for hemodynamic and neurologic monitoring, blood product, antifibrinolytic and procoagulant use, and anesthesia-related adverse events. This special article provides a descriptive summary of relevant findings to date, reflecting the wide variety in anesthesia practice patterns present among institutions and illustrates the functionality of a multisite registry in pediatric cardiac anesthesia which can be utilized both locally and nationally.

Fluid Management in Cardiac Surgery: Results of a Survey in European Cardiac Anesthesia Departments.

OBJECTIVE: To evaluate the current practice of perioperative fluid management in cardiac surgery patients. DESIGN: Multiple choice survey with 26 questions about existing practice of perioperative fluid management in cardiac surgery patients. SETTING: Online survey. PARTICIPANTS: Representatives of anesthesia departments in European cardiac surgical centers. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The study comprised 106 respondents from 18 European countries who mainly worked in teaching hospitals (66%). In 73% of institutions, patients were admitted to a cardiac surgery intensive care unit (ICU) postoperatively. Perfusionists were responsible for the cardiopulmonary bypass priming solution, whereas anesthesiologists were responsible for intraoperative and postoperative fluid management. For cardiopulmonary bypass priming, balanced crystalloids were used in 51.5% of the centers, whereas in 36%, a combination of crystalloid with either synthetic colloid or albumin was administered. Intraoperatively, balanced crystalloids were used by 74% of centers, followed by a combination of crystalloids with synthetic colloids (15%) and other combinations (11%). No colloids were used by 32% of respondents. When colloids were used, gelatin was preferred, compared with hydroxyethyl starches and albumin (60% v 24% v 16%, respectively). Seventy-three percent of respondents, also involved in ICU treatment, did not change their fluid strategy in the ICU compared with their intraoperative strategy. Thirty-two percent of those who changed their strategy either added (32%) or decreased (29%) synthetic colloids or added (32%) or decreased (7%) natural colloids. CONCLUSIONS: Perioperative fluid management in cardiac surgery patients may have changed in the last few years in European centers. Balanced crystalloids now seem to be the preferred solutions, followed by synthetic colloids (mainly gelatins) and albumin.