Author: Richard Newland
Newland, Richard, 2024 The development of intraoperative electronic perfusion data processing to improve the practice of cardiopulmonary bypass, Flinders University, College of Medicine and Public Health
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The intraoperative electronic perfusion data (EPD) collected provide an enormous resource for undertaking studies to provide better understanding and improvement of the practice of cardiopulmonary bypass (CPB), however the application of data for this purpose has been limited. Potentially the most important influence that EPD may have on clinical practice is the identification of modifiable predictors of patient outcome, and with integration of EPD into perfusion registries facilitation of quality improvement through benchmarking. To date, the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) is the only multicentre CPB registry to have reported the integration of EPD. Aiming to improve the understanding and practice of CPB a series of ten publications included in this thesis addressed the application of intraoperative EPD processing from 2006 to 2023.
This thesis demonstrates a considerable undertaking of the development of intraoperative EPD processing to improve the understanding and practice of CPB. This was achieved through the development of:
• Automated generation of CPB quality indicators (QI) from electronic perfusion data to provide a process for continuous QI monitoring.
• A multicentre CPB registry to facilitate reporting and quality improvement through benchmarking (ANZCPR)
• Determining the impact of CPB practice on patient outcome (acute kidney injury) at Flinders Medical Centre
• Identification of modifiable CPB practice predictors of patient outcome (acute kidney injury and 30-day mortality) using ANZCPR multicentre registry data.
This combined body of work has contributed to international guidelines for CPB best practice, recognizing the role of EPD for quality improvement in CPB, and the importance of EPD integration into registries to improve understanding and practice through identification of modifiable factors associated with patient outcome, facilitation of continuous quality monitoring and benchmarking. This work provides the foundation for future development of an international CPB registry to further understanding and improvement of CPB practice by facilitating large international observational studies and registry-based randomized trials, leveraging the registry as a platform for data collection, randomization, and follow-up.
Keywords: Cardiopulmonary bypass, cardiac surgery, electronic intraoperative data
Subject: Medicine thesis
Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Medicine and Public Health
Supervisor: Professor Robert A Baker