Perfusion safety: defining the problem.

Perfusion safety is not an isolated component of cardiac surgery, but encompasses many facets, including equipment, safety devices, conduct of perfusion, surgical technique, vigilance, and communication within the operating room. Over the last 25 years, several surveys have provided an estimation of the occurrence of perfusion-related incidents and documented the frequency with which they affected patient morbidity and mortality. As the focus of attention turned to correcting these problem areas, each subsequent survey demonstrated changes, but also pointed out new areas needing improvement. As technology and education improved, so did results. With refinements in perfusion equipment and techniques, and increasing use of computer assistance and automation, cardiopulmonary bypass should become even safer. The key ingredient, though, will remain the knowledge and expertise of the perfusionist.