Perfusion Instability During Hyperthermic Intraperitoneal Chemotherapy: The Utility of a Problem-solving Flowchart.

Background/aim: During hyperthermic intra-peritoneal chemotherapy (HIPEC), perfusion instability (PI) is defined as the inability to maintain a proper perfusion flow without impairment of the target temperature. The management and resolution of this adverse event is underreported and poorly investigated. The study aimed to evaluate the incidence of PI during closed cytoreductive surgery (CRS)-HIPEC and how a problem-solving approach might limit the effects of this adverse event.

Patients And Methods: A retrospective analysis of patients who underwent CRS-HIPEC at our Institution was performed. PI was defined when the patient's outflow pressure of the circuit was not able to maintain target flow and temperature (1,100 ml/min and 41°C). A step-by-step problem-solving flowchart, which included checking the drain position, proper muscle relaxation, changing the bed position, adjusting the perfusion volume and switching the drain flow switch, was used.

Results: A total of 208 HIPEC procedures were reviewed between May 2018 and January 2023. PI occurred in 21 cases (10.1%). Patients with PI had a significantly longer perfusion time (p<0.001). Although the mean outflow pressure and flow rate were significantly lower in patients with PI (p<0.001), the target temperature was maintained until the end of HIPEC.

Conclusion: A scheduled problem-solving approach by HIPEC perfusionist team was able to resolve most cases of PI. Further research on perfusion technical details and volume calculation is needed to prevent and limit the effects of this complication.