Cerebral Circulatory Support During Low Flow Cerebral Perfusion: A Retrospective Review in a Pediatric Hospital

Excessive hemodilution during cardiopulmonary bypass is associated with decreased oxygen carrying capacity, edema and organ dysfunction. The use of blood products is often necessary to prime the extracorporeal circuit for pediatric Post-Infusion Parameter RC Studies Patients Per Group HC Group Mean HC − CW Mean Diff MA 95% CI Min MA 95% CI Max Sig @ p 0.05 Hematocrit 8 106 28.8 −1.1 −2.2 −0.1 Yes Platelet count 5 74 194 43 24 62 Yes Total protein concentration 3 42 5.4 0.7 0.5 1.00 Yes Colloidal osmotic pressure 3 48 14.4 2.2 1.4 3.1 Yes Fibrinogen concentration 3 55 245 25 −5 55 No Plasma free hemoglobin concentration 3 48 35 4 −4 11 No RC randomized controlled; HC hemoconcentration; CW cell washing; MA meta-analysis; CI confidence interval; Sig statistical significance. 87 ABSTRACTS JECT. 2006;38:82–101 cardiac surgical patients. However, the use of blood products carries serious risks both in the acute and long-term aspects of patient care. Autologous priming of the extracorporeal circuit used in conjunction with ultrafiltration, phramacologic manipulation and cell salvage may decrease the need for blood transfusion in the pediatric cardiac surgical population. We have developed a technique that enables us to perform transfusionless complex congenital heart repair targeting patients as small as 5 kg. Ostrowsky J, BS, CCP, Henderson M, CCP, Hennein H, MD Department of Pediatric Cardiothoracic Surgery, Rainbow Babies and Children’s Hospital, Cleveland, Ohio Ergonomic Perfusion Checklist: Basic Human Factor Design for the Heart Lung Machine Purpose: Ergonomic considerations have not widely been applied to the heart lung machine and perfusion workstation. Henceforth, the purpose of this study was to determine if current workstation designs follow basic ergonomic principles. These principles were put I an easy checklist for perfusionists to use, all for the purpose of making a safer, more efficient design that will decrease musculoskeletal disorders. Methods: Two hospitals were chosen, one where perfusionist’s stand and another where they sit during cases. Detailed measurements of the heart-lung machine and location of all monitors and accessories were recorded in centimeters. A computer assisted design (CAD) program was used to illustrate the maximum reach and visual field for 50th percentile females and males for both hospital designs. A checklist was made of the most important ergonomic considerations. Results: Standing hospital had nothing but the blender within the perfusionist’s maximum reach and the placement of the reservoir resulted in excess neck flexion of over 52°. In addition, the standing hospital’s heart rate, ECG, and pressure monitor was placed 180° behind and 187 cm above the perfusionist resulting in a decrease in perfusionist use. Excess glare and cold temperature were also observed. The sitting hospital had all pump controls and temperature readings linked to an adjustable touch screen monitor allowing most actions to be within the maximum reach. However, the hemodynamics monitor was not in viewing range and the chair used had a minimum height that was higher than the average male and female’s minimum height. This would result in the perfusionist needing to either lean their torso forward or place their feet on the wheels. Conclusions: There are many ergonomic problems with the perfusion workstation, especially with older hospital designs. By using this ergonomic checklist, perfusionists can recognize ergonomic issues more readily and can correct them to increase reaction time, reduce scan time, increase monitor usage, and decrease musculoskeletal impact from extreme reaches of the neck, torso and arms. Ploetz SR, Oliver M, Riley JB Circulation Technology Division, The Ohio State University, Columbus, Ohio A Website for Evidence-Based Practice for Perfusion. What Is It and How Do We Do It? Objectives: Perfusionists have traditionally made clinical decisions based on theory and individual experiences. Yet we know that clinical decisions based on experience do not always result in optimal medical results. Perfusionists must base their clinical decisions on the integration of the highest research evidence available as well as clinical expertise and patient priorities. Educational tools need to be developed for perfusionists and students to use to integrate EBM into clinical practice and the writing of procedure guidelines. Methods: Through The Ohio State University School of Allied Medical Professions’ “The Model Project”, a website for perfusionists is posted and may be used as an educational model for tackling the issues encountered when applying the rules of evidence-based medicine in the clinical setting. Results: The Perfusion section of the Model Project will define the elements of evidencebased practice in the context of clinical perfusion services and patient care. The user will define and understand the different levels of evidence, including the strengths and limitations. The website identifies databases that will lead perfusionists to different levels of evidence. The educational module identifies the steps to evidence-based practice and creating guidelines for perfusion protocols for perfusion services. Outcome: Future perfusion students, current perfusion students, and clinical perfusionists may use the website to understand how to evaluate the current body of available perfusion literature and be able to apply the rules of EBM to their clinical practice.