The major problem for perfusionists during cardiopulmonary bypass: Vent aspirator not sucking! solutions

Bisar Amac; Mesut Engin

doi:10.5281/zenodo.17278013

Authors

Bisar Amac Harran University, Faculty of Health Sciences, Department of Perfusion, Sanliurfa, Turkey https://orcid.org/0000-0003-0320-4239
Mesut Engin Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey https://orcid.org/0000-0003-2418-5823

DOI:

https://doi.org/10.5281/zenodo.17278013

Keywords:

Cardiopulmonary bypass, Perfusionist, Venting, Vent problem, Vent aspirator not sucking, Technical complications

Abstract

Objective: The objective of this study is to investigate the frequency, causes and solutions of the problem of ‘vent aspirator not sucking’ encountered during cardiopulmonary bypass (CPB) and to evaluate its relationship with professional experience, institutional environment and educational status.

Materials and methods: A descriptive cross-sectional study was conducted through an online survey of 186 actively practicing perfusionists across Turkey. A 17-item structured questionnaire was used to collect data on demographics, vent usage habits, problem frequency, perceived causes, interventions, and training background. Data were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression.

Results: Approximately 65% of participants reported experiencing the vent problem occasionally or frequently, with the rewarming phase being the most common stage of occurrence (45.7%). The most frequently cited causes included incorrect cannula positioning (72.6%) and vacuum system issues (59.1%). Less experienced perfusionists and those working in private hospitals or high-volume centers reported significantly more problems. Receiving specific training on vent management reduced the risk by 45% (OR = 0.55, p = 0.035), yet 58.1% of perfusionists indicated insufficient training. Moreover, only 18.3% reported having standard protocols in their institutions.

Conclusion: The “vent aspirator not sucking” issue is a widespread and multifactorial technical problem during CPB, significantly affected by experience, institutional factors, and training. Addressing this challenge requires the development of standardized procedures, structured education programs, and increased awareness of alternative venting strategies to improve patient safety and surgical outcomes.

References

Holman WL, Timpa J, Kirklin JK. Origins and Evolution of Extracorporeal Circulation: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol. 2022;79(16):1606-22.

Whiting D, Yuki K, DiNardo JA. Cardiopulmonary bypass in the pediatric population. Best Pract Res Clin Anaesthesiol. 2015;29(2):241-56.

Kashiwa K. The Management Methods for Cardiopulmonary Bypass and Control Features in the Modern Heartlung Machines. Kyobu Geka. 2025;78(10):787-92.

Passaroni AC, Silva MA, Yoshida WB. Cardiopulmonary bypass: development of John Gibbon's heart-lung machine. Rev Bras Cir Cardiovasc. 2015;30(2):235-45.

Condello I, Santarpino G. Cardiopulmonary Bypass-How I Teach It: The Perfusionist's Point of View. Ann Thorac Surg. 2020;110(4):1437.

Momose N. Cardiopulmonary Bypass System and Perfusion. Kyobu geka. The Japanese journal of thoracic surgery. 2018;71(10):774-8.

Little AG, Lin CY, Wernly JA, Langmuir VK, Bilfinger TV, Levett JM, et al. Use of the pulmonary artery for left ventricular venting during cardiac operations. J Thorac Cardiovasc Surg. 1984;87(4):532-8.

Orihashi K, Ueda T. "De-airing" in open heart surgery: report from the CVSAP nation-wide survey and literature review. Gen Thorac Cardiovasc Surg. 2019;67(10):823-34.

Kumamoto T, Hiraoka C, Murakami K, Fujita M, Kunitoku Y, Kato K. Misplacement of left ventricular vent into the aortic root during a re-do Bentall procedure: a case report. JA Clin Rep. 2023;9(1):16.

Sanders LH, Chen W, Schönberger JP, Shehatha J, Newman MA. Use of the Seldinger type movement over a J-shaped stylet for left ventricular vent insertion. Ann Thorac Surg. 2009;88(6):2050-1.

Mukherji J, Hood RR, Edelstein SB. Overcoming Challenges in the Management of Critical Events During Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth. 2014;18(2):190-207.

Amaç B, Bağış MZ. Evaluation of Current Professional Practices of Perfusionists: Survey Study. J Biotechnol and Strategic Health Res. 2023;7(4):239-48.

Tribble C. Everything You Need to Know about Venting during Cardiac Surgery (And It's More than You Thought!). Heart Surg Forum. 2023;26(5):E666-E671.

Gerstein NS, Panikkath PV, Mirrakhimov AE, Lewis AE, Ram H. Cardiopulmonary Bypass Emergencies and Intraoperative Issues. J Cardiothorac Vasc Anesth. 2022;36(12):4505-22.

Stammers AH, Mejak BL. An update on perfusion safety: does the type of perfusion practice affect the rate of incidents related to cardiopulmonary bypass?. Perfusion. 2001;16(3):189-98.

Borger MA, Feindel CM. Cerebral emboli during cardiopulmonary bypass: effect of perfusionist interventions and aortic cannulas. J Extra Corpor Technol. 2002;34(1):29-33.

Sai Krishna C, Naresh Kumar PV, Satpathy SK, Ram Mohan K, Ramesh Babu V. Rupture of extra-corporeal circuit tubing during cardiopulmonary bypass. J Extra Corpor Technol. 2008;40(1):74-6.

Durukan AB, Gurbuz HA, Ozcelik G, Yorgancioglu C. Electrical failure during cardiopulmonary bypass: a critical moment. Kardiochir Torakochirurgia Pol. 2016;13(2):143-4.

Bilgili A, Örkeli EK, Bolcal C. Kardiyopulmoner baypas çıkış süreci, karşılaşılan zorluklar ve süreç yönetimi. Cardiovasc Perf Nurs 2022;1(1):68-77.

Kirklin J, Barratt-Boyes B. Cardiac Surgery. John Wiley & Sons: New York, NY. 1986.