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Experts Share Tips To Achieve Blood Savings
Terumo sponsored three Optimizing Cardiac Surgery® educational sessions at the recent Mechanisms of Perfusion meeting on May 14, 2015.
Industry experts presented clinical topics that are top-of-mind for perfusionists — limiting transfusions, blood saving techniques and using body mass index to determine the oxygenator — and the highlights are shared in this article.
"Transfusions and Their Association with Post-operative Morbidity and Mortality"
Donald S. Likosky, Ph.D., Associate Professor, Department of Cardiac Surgery, University of Michigan, spoke about the importance of blood conservation. Dr. Likosky is also the Director of the PERForm registry (performregistry.org), which has been used by many institutions as a foundation for their local quality improvement initiatives.
"Perfusionists are integral members of the cardiac surgical team," says Dr. Likosky.
Ample room exists for these teams to leverage data to assess the quality of care delivered with their institution. He cites a number of studies highlighting the importance of multi-disciplinary teams for both blood conservation (Ferraris) and patient safety (Wahr).
Dr. Likosky suggests one approach to evolve a perfusion practice:
- Convene cardiac surgical team members to discuss how perfusionists may contribute to the team's shared goals. This goal should have an impact on the quality and safety of cardiac surgical care.
- Share evidence-based literature concerning the agreed upon area of focus, and which data elements might be instrumental in assessing the practice.
- Based on these discussions, identify and begin collecting data elements, and develop a dashboard.
- Reconvene the group to discuss the data and its implications — and next steps for further data collection, and targeted areas of improvement.
"Saving Every Last Drop, The Total Impact of a Prescriptive Oxygenator Protocol"
Jason Penn, B.A., C.C.P., Director of Perfusion, Bronson Methodist Hospital, shared how his hospital implemented a Prescriptive Oxygenation™ approach and how they use data to support their decisions.
"To start a prescriptive oxygenation program, you first need to ascertain its purpose and then illustrate measured improvements," says Mr. Penn.
"As the integrated oxygenator has the most impact, it is a patient directed circuit approach that defines the amount of crystalloid volume that can be displaced during RAP/AP or the amount of volume burdened to the patient," he says.
"It is not a fad to try and save patients from getting transfused or to decrease the number of units a patient attains," Mr. Penn adds.
"Optimizing Cardiopulmonary Bypass Further: Right-sizing, Autologous Prime Displacement and Adjusting Blood Flow to Body Mass Index"
Jeffrey B. Riley, M.H.P.E., C.C.P., Mayo Clinic Hospital, shared how the Mayo Clinic right-sizes the extracorporeal circuit to the patient; discussed the clinical results of complete circuit autologous prime displacement; and communicated the method and results to adjust CPB target blood flow to a lower body mass.
"The minimum oxygenator/reservoir/tubing combination is selected for each patient based on the procedure and the patient's needs," says Mr. Riley. "We study pre-op data to glean an optimal CPB target blood flow. Based on manufacturer's specifications, we minimize the circuit based on the target blood flow.
"Additionally, the use of a smaller perfusion circuit makes for a smaller static volume, allowing for less autologous blood prime and a higher HB nadir.
"If a patient's BMI is greater than 35 kg/m2, many of our perfusionists will adjust the patient's body weight equivalent to a BMI of 28-30. We use the adjusted body weight to estimate a lean BSA and a lower target blood flow rate to use a smaller ECC," he says. "We typically will not use a BMI-adjusted CPB target blood flow less than 1.8 L/min/m2 based on the high BMI native BSA."
For information on how Terumo products can help your program with some of these techniques, contact your Terumo Cardiovascular Group Sales Representative today.
Ferraris, et al. 2011 Update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines. Ann Thorac Surg. 2011; 91:944-982.
Wahr, et al. Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork: A
Scientific Statement from the American Heart Association. Circulation. 2013. 128(10):1139-69.
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