Common Mistakes in Perfusion and How to Avoid Them.

Perfusionists play a critical role in cardiac surgery and extracorporeal support, ensuring optimal oxygenation and circulation during procedures. However, given the complexity of the field, even experienced professionals can make mistakes. Recognizing these common errors and understanding how to prevent them is essential for patient safety and improved outcomes.

1. Inadequate Preoperative Equipment Checks

Mistake:

Failure to thoroughly check the heart-lung machine, oxygenator, roller pumps, and circuit components before surgery can lead to unexpected malfunctions during a procedure.

Prevention:

• Follow a standardized pre-bypass checklist before every case.
• Perform a full functional test of the equipment, including occlusion settings and pump calibration.
• Verify gas supply, venous reservoir levels, and alarms.

📌 Citation: Mejak, B. L., Stammers, A. H., Rauch, E. D., et al. (2000). «A retrospective study on perfusion incidents and safety practices.» Perfusion, 15(6), 500-508.

2. Incorrect Blood Flow Calculations

Mistake:

Miscalculating cardiac index or blood flow rates based on incorrect patient parameters (e.g., BSA, temperature corrections) can lead to inadequate perfusion or overcirculation, causing complications like edema or metabolic acidosis.

Prevention:

• Double-check patient parameters and flow calculations using validated formulas.
• Utilize real-time perfusion monitoring systems to adjust flows dynamically.
• Collaborate with anesthesia to fine-tune metabolic and hemodynamic goals.

📌 Citation: Gravlee, G. P. (2018). Cardiopulmonary Bypass: Principles and Practice. Lippincott Williams & Wilkins.

3. Poor Management of Anticoagulation

Mistake:

Failing to properly monitor and maintain anticoagulation (e.g., heparin dosage adjustments, inadequate ACT monitoring) increases the risk of clotting or bleeding complications.

Prevention:

• Ensure accurate heparin dosing based on weight and ACT response.
• Perform serial ACT testing throughout bypass.
• Be prepared with protamine reversal strategies and backup heparin protocols.

📌 Citation: Despotis, G. J., Avidan, M. S., & Hogue, C. W. (2001). «Mechanisms and attenuation of hemostatic activation during cardiopulmonary bypass.» The Annals of Thoracic Surgery, 72(5), S1821-S1831.

4. Unrecognized Air Embolism

Mistake:

Failure to detect or remove air from the circuit can result in air embolism, which may cause neurological damage or fatal complications.

Prevention:

• Use bubble detectors and air filters in the arterial line.
• Routinely de-air the circuit and monitor reservoir levels.
• Follow proper venous line management to prevent air entrainment.

📌 Citation: Gaylor, J. D., Lick, S. D., & Fitzgerald, D. C. (2006). «Air embolism during cardiopulmonary bypass: Risk factors and prevention strategies.» Perfusion, 21(3), 193-200.

5. Failure to Recognize Changes in Patient Physiology

Mistake:

Over-focusing on pump mechanics and ignoring patient metabolic acidosis, hypothermia, or oxygen delivery-demand mismatch can lead to poor patient outcomes.

Prevention:

• Continuously assess venous saturation (SvO₂), lactate levels, and perfusion indices.
• Work closely with the anesthesia team to optimize temperature, fluid balance, and vasoactive support.
• Adjust pump settings dynamically based on patient response rather than fixed numbers.

📌 Citation: Ranucci, M., Johnson, I., & Willcox, T. (2010). «Goal-directed perfusion: Hemodynamic and metabolic considerations.» The Journal of Extra-Corporeal Technology, 42(2), 89-99.

6. Neglecting Emergency Preparedness

Mistake:

Being unprepared for catastrophic events like circuit rupture, oxygenator failure, or pump malfunction can lead to life-threatening delays in patient management.

Prevention:

• Regularly rehearse emergency protocols for pump failure, massive air embolism, and accidental circuit disconnection.
• Keep backup equipment and primed circuits ready in high-risk cases.
• Train the OR team on role assignments in case of an emergency.

📌 Citation: Stammers, A. H. (2019). «Risk management in perfusion: Understanding and mitigating hazards.» Perfusion, 34(1), 5-12.

Conclusion

Mistakes in perfusion can have serious consequences, but most are preventable with vigilance, continuous education, and adherence to protocols. By recognizing common errors and applying these prevention strategies, perfusionists can improve patient safety, reduce complications, and enhance overall surgical outcomes.