Quality control system for cardiopulmonary bypass in clinic: Establishment and practice in West China Hospital_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Xiali , YU Xiang , WANG Bo , LUO Ming , TAN Zhaoxia , LUO Dan , FAN Jinge , ZHOU Xiujuan , LIU Ting , QIN Zhen , ZHOU Ronghua , DU Lei ,  XIONG Jiyue

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

XIONG Jiyue, Email: Xiongjiyue028@163.com

Keywords：

Cardiopulmonary bypass; quality control system in clinic; cardiac surgery

DOI：

10.7507/1007-4848.202506046

Video：

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Quality control of cardiopulmonary bypass (CPB) in clinic is key to keep patients’ safety. In recent years, a quality control system for CPB is well developed in West China Hospital, including a monitoring part and a clinical management. After 5 years of its implementation, it has been shown that this system not only ensures patients’ safety but also enhances the quality of CPB, reducing the incidence of CPB-related complications and improving the prognosis. This article will introduce in details the implementation and standards of this clinical quality control system. We believe the system may help establish CPB quality control standards in China.

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4.	中国生物医学工程学会体外循环分会, 中华医学会胸心血管外科学分会, 中国医师协会心血管外科医师分会. 中国体外循环专业技术标准(2021版). 中国体外循环杂志, 2021, 19(2): 67-72.Chinese Society of Extracorporeal Circulation, Chinese Society for Thoracic and Cardiovascular Surgery, Chinese Association of Cardiovasclar Surgeons. Chinese professional technical standards for extracorporeal circulation (2021 edition). Chin J Extracorporeal Circ, 2021, 19(2): 67-72.
5.	Kumamoto T. Acute aortic dissection during minimally invasive cardiac surgery: a case report. JA Clin Rep, 2025, 11(1): 6.
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7.	喻翔, 杜磊, 熊际月. 心脏停搏液的临床应用进展. 中国体外循环杂志, 2023, 21(2): 124-128.Yu X, Du L, Xiong JY. Clinical application progress of cardiac arrest fluid. Chin J Extracorporeal Circ, 2023, 21(2): 124-128.
8.	Yan W, Wang C, Gao X, et al. Efficacy and safety of the blood-based cardioplegia solution Huaxi-1 in cardiopulmonary bypass surgery: protocol for a multicentre randomised controlled trial. BMJ Open, 2025, 15(2): e095660.
9.	Shepherd SJ, Pearse RM. Role of central and mixed venous oxygen saturation measurement in perioperative care. Anesthesiology, 2009, 111(3): 649-656.
10.	Svenmarker S, Häggmark S, Östman M, et al. Central venous oxygen saturation during cardiopulmonary bypass predicts 3-year survival. Interact Cardiovasc Thorac Surg, 2013, 16(1): 21-26.
11.	Svenmarker S, Hannuksela M, Haney M. A retrospective analysis of the mixed venous oxygen saturation as the target for systemic blood flow control during cardiopulmonary bypass. Perfusion, 2018, 33(6): 453-462.
12.	Liu X, Luo D, Zhang J, Du L. Distribution and relative expression of vasoactive receptors on arteries. Sci Rep, 2020, 10(1): 15383.
13.	Wang Y, Yang H, Du K, et al. Huaxi integrated blood management reduces the red blood cell transfusion for on-pump cardiac surgery: a quasi-experimental study. J Clin Anesth, 2024, 98: 111593.
14.	体外循环中负压辅助静脉引流装置操作规范流程及使用标准. 中国体外循环杂志, 2023, 21(5): 259-262.Operating procedures and usage standards for negative pressure-assisted venous drainage devices in extracorporeal circulation. Chin J Extracorporeal Circ, 2023, 21(5): 259-262.
15.	Godoy DA, Rovegno M, Lazaridis C, et al. The effects of arterial CO₂ on the injured brain: two faces of the same coin. J Crit Care, 2021, 61: 207-215.
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18.	刘锋, 江瑜, 郝星, 等. 2021年中国体外循环实践调查: 现状与挑战. 中华胸心血管外科杂志, 2022, 38: 537-542.Liu F, Jiang Y, Hao X, et al. 2021 China extracorporeal circulation practice investigation: current situation and challenges. Chin J Thorac Cardiovasc Surg, 2022, 38: 537-542.
19.	喻翔, 谭赵霞, 刘侠丽, 等. 华西医院体外循环信息记录系统的介绍及临床应用. 中国体外循环杂志, 2025, 23(1): 72-75,86.Yu X, Tan ZX, Liu XL, et al. Introduction and clinical application of the extracorporeal circulation information recording system of West China Hospital. Chin J Extracorporeal Circ, 2025, 23(1): 72-75,86.
20.	李呤雨, 谭赵霞, 秦臻, 等. 华西综合血液管理策略降低体外循环后急性肾损伤发生风险. 中国体外循环杂志, 2022, 20(3): 132-137,178.Li LY, Tan ZX, Qin Z, et al. West China's comprehensive blood management strategy reduces the risk of acute kidney injury after cardiopulmonary bypass. Chin J Extracorporeal Circ, 2022, 20(3): 132-137,178.
21.	Qin Z, Zhou Y, Wang B, et al. "Brain-first" total body retrograde perfusion and retrograde cerebral perfusion in hemi-arch replacement. Heart Surg Forum, 2024, 27(5): E511-E519.
22.	Zhang Q, Zhao W, Gao S, et al. Quality management of a comprehensive blood conservation program during cardiopulmonary bypass. Ann Thorac Surg, 2022, 114(1): 142-150.
23.	Vives M, Hernandez A, Parramon F, et al. Acute kidney injury after cardiac surgery: prevalence, impact and management challenges. Int J Nephrol Renovasc Dis, 2019, 12: 153-166.
24.	Elbatarny M, Stevens LM, Dagenais F, et al. Hemiarch versus extended arch repair for acute type A dissection: results from a multicenter national registry. J Thorac Cardiovasc Surg, 2024, 167(3): 935-943. e5.

1. 侯晓彤, 章晓华, 李欣. 《中国体外循环专业技术标准》——体外循环质量控制的基石. 中国体外循环杂志, 2021, 19(2): 65-66,72.Hou XT, Zhang XH, Li X. Professional technical standards for extracorporeal circulation in China: the cornerstone of quality control in extracorporeal circulation. Chin J Extracorporeal Circ, 2021, 19(2): 65-66,72.
2. Kunst G, Milojevic M, Boer C, et al. EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Br J Anaesth, 2019, 123(6): 713-757.
3. 刘侠丽, 谭赵霞, 秦臻, 等. 华西综合血液管理策略减少体外循环患者异体血需要. 中国体外循环杂志, 2022, 20(4): 200-206,225.Liu XL, Tan ZX, Qin Z, et al. The comprehensive blood management strategy of West China Hospital reduces the need for allogeneic blood in patients undergoing cardiopulmonary bypass. Chin J Extracorporeal Circ, 2022, 20(4): 200-206,225.
4. 中国生物医学工程学会体外循环分会, 中华医学会胸心血管外科学分会, 中国医师协会心血管外科医师分会. 中国体外循环专业技术标准(2021版). 中国体外循环杂志, 2021, 19(2): 67-72.Chinese Society of Extracorporeal Circulation, Chinese Society for Thoracic and Cardiovascular Surgery, Chinese Association of Cardiovasclar Surgeons. Chinese professional technical standards for extracorporeal circulation (2021 edition). Chin J Extracorporeal Circ, 2021, 19(2): 67-72.
5. Kumamoto T. Acute aortic dissection during minimally invasive cardiac surgery: a case report. JA Clin Rep, 2025, 11(1): 6.
6. Sabe SA, Harris DD, Broadwin M, et al. Cardioprotection in cardiovascular surgery. Basic Res Cardiol, 2024, 119(4): 545-568.
7. 喻翔, 杜磊, 熊际月. 心脏停搏液的临床应用进展. 中国体外循环杂志, 2023, 21(2): 124-128.Yu X, Du L, Xiong JY. Clinical application progress of cardiac arrest fluid. Chin J Extracorporeal Circ, 2023, 21(2): 124-128.
8. Yan W, Wang C, Gao X, et al. Efficacy and safety of the blood-based cardioplegia solution Huaxi-1 in cardiopulmonary bypass surgery: protocol for a multicentre randomised controlled trial. BMJ Open, 2025, 15(2): e095660.
9. Shepherd SJ, Pearse RM. Role of central and mixed venous oxygen saturation measurement in perioperative care. Anesthesiology, 2009, 111(3): 649-656.
10. Svenmarker S, Häggmark S, Östman M, et al. Central venous oxygen saturation during cardiopulmonary bypass predicts 3-year survival. Interact Cardiovasc Thorac Surg, 2013, 16(1): 21-26.
11. Svenmarker S, Hannuksela M, Haney M. A retrospective analysis of the mixed venous oxygen saturation as the target for systemic blood flow control during cardiopulmonary bypass. Perfusion, 2018, 33(6): 453-462.
12. Liu X, Luo D, Zhang J, Du L. Distribution and relative expression of vasoactive receptors on arteries. Sci Rep, 2020, 10(1): 15383.
13. Wang Y, Yang H, Du K, et al. Huaxi integrated blood management reduces the red blood cell transfusion for on-pump cardiac surgery: a quasi-experimental study. J Clin Anesth, 2024, 98: 111593.
14. 体外循环中负压辅助静脉引流装置操作规范流程及使用标准. 中国体外循环杂志, 2023, 21(5): 259-262.Operating procedures and usage standards for negative pressure-assisted venous drainage devices in extracorporeal circulation. Chin J Extracorporeal Circ, 2023, 21(5): 259-262.
15. Godoy DA, Rovegno M, Lazaridis C, et al. The effects of arterial CO₂ on the injured brain: two faces of the same coin. J Crit Care, 2021, 61: 207-215.
16. Palmer BF, Clegg DJ. Respiratory acidosis and respiratory alkalosis: core curriculum 2023. Am J Kidney Dis, 2023, 82(3): 347-359.
17. 端木剑宇, 梁永年, 喻翔, 等. 经膜肺出气口实时二氧化碳监测用于评估二氧化碳分压的临床意义和可行性. 中国体外循环杂志, 2024, 22(4): 318-323.Duanmu JY, Liang YN, Yu X, et al. The clinical significance and feasibility of real-time carbon dioxide monitoring at transmembrane lung exhaust ports for evaluating partial pressure of carbon dioxide. Chin J Extracorporeal Circ, 2024, 22(4): 318-323.
18. 刘锋, 江瑜, 郝星, 等. 2021年中国体外循环实践调查: 现状与挑战. 中华胸心血管外科杂志, 2022, 38: 537-542.Liu F, Jiang Y, Hao X, et al. 2021 China extracorporeal circulation practice investigation: current situation and challenges. Chin J Thorac Cardiovasc Surg, 2022, 38: 537-542.
19. 喻翔, 谭赵霞, 刘侠丽, 等. 华西医院体外循环信息记录系统的介绍及临床应用. 中国体外循环杂志, 2025, 23(1): 72-75,86.Yu X, Tan ZX, Liu XL, et al. Introduction and clinical application of the extracorporeal circulation information recording system of West China Hospital. Chin J Extracorporeal Circ, 2025, 23(1): 72-75,86.
20. 李呤雨, 谭赵霞, 秦臻, 等. 华西综合血液管理策略降低体外循环后急性肾损伤发生风险. 中国体外循环杂志, 2022, 20(3): 132-137,178.Li LY, Tan ZX, Qin Z, et al. West China's comprehensive blood management strategy reduces the risk of acute kidney injury after cardiopulmonary bypass. Chin J Extracorporeal Circ, 2022, 20(3): 132-137,178.
21. Qin Z, Zhou Y, Wang B, et al. "Brain-first" total body retrograde perfusion and retrograde cerebral perfusion in hemi-arch replacement. Heart Surg Forum, 2024, 27(5): E511-E519.
22. Zhang Q, Zhao W, Gao S, et al. Quality management of a comprehensive blood conservation program during cardiopulmonary bypass. Ann Thorac Surg, 2022, 114(1): 142-150.
23. Vives M, Hernandez A, Parramon F, et al. Acute kidney injury after cardiac surgery: prevalence, impact and management challenges. Int J Nephrol Renovasc Dis, 2019, 12: 153-166.
24. Elbatarny M, Stevens LM, Dagenais F, et al. Hemiarch versus extended arch repair for acute type A dissection: results from a multicenter national registry. J Thorac Cardiovasc Surg, 2024, 167(3): 935-943. e5.

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