KPIs: What They Mean and Why They Matter

A key performance indicator (KPI) is a type of performance measurement, and KPIs evaluate the success of a particular activity that your organization is engaged in. KPIs are critical in understanding the health of your business so you can make necessary adjustments to achieve your goals or outcomes. Establishing the right KPIs will help you achieve your desired results faster. The performance of the indicators below is assessed in first-time patients undergoing coronary artery bypass graft surgery.

Perfusion Performance Indicators 

Specific indicators have been determined for quality purposes based on best available evidence gathered from peer-reviewed, indexed journals on cardiac surgery, anesthesia, and perfusion. These indicators’ numeric values were established as a guideline to enhance perfusion, improve patient outcomes, and lower the risk of cardiopulmonary bypass patients. 

Indicator: Net Prime Volume will be less than 900 mL

Target Value: ≥ 80%

Patients with anemia who undergo cardiac surgery with iatrogenic hemodilution exacerbating the effect experience poor outcomes. To optimally manage intraoperative fluid administration, prime volumes should be reduced and surgeons should employ methodologies to maintain red cell mass circulation. Reducing circuit size while achieving adequate perfusion has led to postoperative organ function and better patient outcomes.

Indicator: Minimum Cardiac Index (CI) during CPB  ≥ 1.8 LPM/M2 BSA

Target Value: ≥ 85% ≥ 1.8 LPM/M2 BSA

During cardiopulmonary bypass (CPD), the flow rate ensures that nutrients are delivered and removes metabolic waste, allowing the patient to reach adequate homeostasis. Developing lactic acidosis or increasing CO2 levels will determine the minimum flow rate. Blood flow rates are typically maintained between 1.8-2.4 LPM/M2 BSA. Anything below 1.6 can result in reduced SvO2, increasing acidemia.

Indicator: Activated Clotting Time (ACT) during CPB will be ≥ 400 seconds

Target Value: ≥ 90%

The effectiveness of anticoagulation protocols has been altered due to recent changes in calculating the potency of unfractionated heparin during cardiopulmonary bypass. Thrombin generates when inadequate anticoagulation is present. Thrombi can develop, resulting in circuit and organ occlusion and illicit consumptive coagulopathy. Surgeons should maintain an activated clotting time (ACT) greater than 400 seconds during CPD to reduce the risk of thromboembolic complications. 

Indicator: Lowest Base Excess (BE) during CPB > -4

Target Value: > 90%

Metabolic acidosis can occur during cardiopulmonary bypass (CPD) when inadequate perfusion or tissue hypooxygenation with activated anaerobic metabolic pathways. Acidosis can also develop from hypothermia, extreme hemodilution, low flow CPD, and excessive neurohormonal activation. A low base excess level is associated with poor outcomes, increasing patients’ intensive care unit.

Indicator: Packed Red Blood Cell (PRBC) Transfusion during CPD (includes prime)

Target Value: < 15%

Hemodilution increases the risk of bleeding and allogeneic packed red blood cell transfusion. When PRBC is transfused in the intra or postoperative period, it can lead to unfavorable outcomes, even increasing mortality risk. An integral component for cardiac surgery patients should be the judicial administration of blood products within your hospital’s blood management program.

Indicator: Highest Arterial Blood Temperature < 37℃ 

Target Value: ≥ 85%

Hypothermia during CPD can influence outcomes and affect neurological injury. Arterial perfusate maximum temperature should be kept at less than 37℃. Higher arterial blood temperatures can increase the patient’s risk for acute kidney injury. 

Indicator: Highest Intraoperative Glucose < 180 mg/dL

Target Value: ≥ 60%

Managing glucose during the intra and postoperative periods of cardiac surgery can improve patient outcomes. STS guidelines recommend maintaining blood glucose levels at or lower than 180 mg/dL for better results. 

Indicator: Lowest SvO2 during CPB ≥ 60%

Target Value: ≥ 90%

Regulating blood flow during CPD balances supply and demand economies of oxygenation. Mixed venous saturation monitoring SvO2 effectively guides blood management and transfusion rates. Although currently not known, declining levels of SvO2 likely yield adverse outcomes.

Indicator: Hematocrit on CPB greater than 24%

Target Value: ≥ 60%

Lower hematocrit levels during CPD are associated with poorer outcomes and more significant complications. Patient tolerance to anemia during CPD varies significantly, but most research shows that levels < 24% result in reduced outcomes. 

Indicator: Change in Hematocrit from 1st in O.R. > 85% to First On CPB < 8 percentage points

Target Value: ≥ 85%

Reducing fluids during cardiac surgery reduces the risk for iatrogenic anemia. Prime volume reductions and carefully administering intraoperative fluids result in higher levels of red cell mass and reduce allogeneic red blood cell transfusions. Reducing the degree of hemodilution will result in decreased cardiac surgery complications. 

Perfusion Services 

SpecialtyCare is the largest provider of perfusion services in the U.S. More than 400 hospitals trust our services to support 150,000 procedures and 1 in 8 heart surgeries performed in the country every year. SpecialtyCare specializes in top-tier outsourced clinical services, and we can help you create a perfusion program that meets all of your needs. Working seamlessly with your operating room can increase OR efficiency, reduce costs, and improve patient outcomes. 

About SpecialtyCare

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