Perfusion Measures and Outcomes (PERForm) Registry: First Annual Report

Background: The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology.  Methods: This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (>18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized.  Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported.   Results: A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 centers.  Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years.  Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time.  The use of conventional ultrafiltration decreased over the study period (2019 vs 2022; 27.1% vs 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs 75.9%). Conclusion: Few robust clinical registries exist to collect data regarding the practice of CPB.  Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.