Bylaws Committee

Transcription

Bylaws Committee

CALENDAR OF EVENTS
January 1 - April 1 – Applications accepted for the Fellow of
Pediatric Perfusion designation.
Request an application before
March 1. Requirements here:
www.amsect.org/page/pediatricfellow-requirements.
January 17 – Ballot opens for
leadership elections. Statements
from the candidates can be found
in this issue of AmSECT Today
(Page 8).
February 13 – Registration rates
increase and hotel block closes
for AmSECT’s 54th International
Conference, The Broadmoor Resort, Colorado Springs CO. www.
amsect.org/p/cm/ld/fid=1203
March 15-19 – AmSECT’s 54th
International Conference, The
Broadmoor Resort, Colorado
Springs CO featuring workshops,
GDT Symposium and keynote
speakers. www.amsect.org/p/cm/
ld/fid=1203
September 21-24 – AmSECT’s
Quality and Outcomes, Sheraton
New Orleans, New Orleans LA.
Visit www.amsect.org for additional information.
AmSECT
January/February 2016 • Volume 19 Issue 1
M E S S AGE FR OM THE P R ES IDENT
oday
We Stand on the Shoulders
of Countless People
Jeffrey B. Riley MHPE CCT CCP
AmSECT President
You will read my message in the new year,
however, I am writing it in 2015. When I opened
Facebook today, Thanksgiving here in the USA, it
was suggested that I let my friends know for what
I am thankful. Though I am sure you were thankful
on Thanksgiving Day, it can’t hurt to be a little more
thankful all the time, a mindset I struggle to realize
daily. I hope my words encourage you to pause
and recount all for which you are thankful as you
begin another year.
I have so much to be thankful for beginning
with my family and children, my relatives and my
friends on and off Facebook. My wife and children
have taken their vacations at AmSECT conference
sites for decades; I have taken my paid time off
the same way to ensure we spend time together.
However, my family knows what great professions
perfusion and teaching are for our family. They
are just as thankful as I am for the opportunities
we experience.
There is one
group I do not talk
about much in my
president’s messages that I am
particularly thankful for – the perfusion team at Mayo Clinic in
Rochester, Minnesota. My teammates and I work
for one of the top 50 U.S. employers as rated by
employees. We take our institution’s values and
mission seriously. We work hard to keep Mayo
Clinic at the top in cardiology and cardiac surgery.
The needs of our patients always come first, but
the needs of our employees are a close second.
One of my mentors told me that if you are the
leader and the smartest person in the room, you are
in trouble. I wholeheartedly agree and have always
tried to surround myself with the best and brightest, both as members of the team and as students
enrolled in our educational programs.
Continued on page
D I G I TA L TA B L E O F C O N T E N T S
What’s Inside
amsectu.org
Disclaimer: All the information in AmSECT
Today is published in good faith and for
general information purposes. AmSECT
does not make any warranties about the
completeness, reliability and accuracy of
this information. Any action you take based
upon the information in AmSECT Today is
strictly at your own risk and AmSECT will
not be liable for any losses and damages
in connection with the use of newsletter
content.
Editor’s Note..............................................
Self Quiz....................................................
Theme Article ............................................
JECT Announces New Editor .......................
Welcome New Members ..............................
JECT Open Access .......................................
AmSECT Today Themes ..........................
Little Hearts ....................................................
New AmSECT Office Open for Business .....
Foundation Donors ........................................
National Awards Nominees ......................
Weighing the Evidence ...............................
2016 AmSECT Election Candidates..........
Upcoming AmSECT Meetings ..................
From My Time in the Trenches .................
Self Quiz Answers ....................................
Broken Hearts............................................
Thanks to our Sponsors ...........................
Student View Point ...................................
Page 2 AmSECT Today - January/February 2016
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AmSECT Today - January/February 2016
Page 3
E D I T O R ’ S N O TE
By Tom Rusk CCP
AmSECT Today Editor
What’s in This Issue?
The many contributors to AmSECT Today have delivered yet
another exciting issue loaded with practical perspectives, observations
and solutions drawn from clinical experiences. This issue centers on
themes of extended life support and transport medicine. Life support
is at the center of our worlds as perfusionists – it’s an everyday reality
for all of us who are clinically active. Transport medicine concerns are
far more common issues for some perfusionists than others. Each
of us, however, stands to gain from actively considering and better
understanding the issues. Transport knowledge can apply to an
Tom Rusk CCP
intrahospital transfer as well as interfacility transfer.
What does this issue of AmSECT Today have in store for you? AmSECT President Jeff Riley
opens the issue with recognition that we as a profession and as individual clinicians have much
to be thankful for and many people to acknowledge for our present successes. Shahna Bronson
offers an extension of these ideas by identifying that perfusion is anything but routine, and as a
profession, we are expected to find ways to safely and economically support both everyday cases
and novel interventions. The reasoning, basic circuit configuration and experience of one center
that uses Cardiohelp to meet this demand is shared in Shahna’s article.
Kellen Goldberg reveals in an informative (especially for we adult clinicians) piece his center’s
“exit to ECMO” process, which addresses planning and initiation of ECMO for neonates with congenital defects who otherwise may not survive outside the womb. Lest you think this isn’t applicable
to your practice, Kellen provides the checklist used in the process. We can always learn something
by seeing how others meet the challenges they face. Mat Medlin specifically discusses interfacility
ECMO transport and offers several points for consideration in this issue’s theme article.
Laura Rigg encourages us to maintain “student-like” enthusiasm for the challenges we face as
clinicians. The example she explores is the thorny issue of measuring anticoagulation for ECMO. Our
student contributor to this issue, Brent Thye, brings us his observations and knowledge of transport
medicine gained over 10 years as a paramedic. Brent’s work provides an exemplar of the enthusiasm
about which Laura encourages us all to maintain. Isaac Chinnappan’s quiz this month may challenge
you to think about details you haven’t dwelled on since you were preparing for your board exams!
Gary Grist asks a penultimate question every perfusionist will hopefully face someday: What will
you do after your clinical career in perfusion reaches its conclusion? Several quotes from retired,
yet involved, perfusionists help answer the final question every perfusionist will face: Why will you
do what you choose to do after your clinical career has come to its end? The reasoning offered by
these retired perfusionists shows that some of us will choose to remain shoulders upon which the
profession may stand.
AmS EC T’s
NATIONAL OFFICE
330 N. Wabash Avenue
Suite 2000
Chicago, Illinois 60611
Phone (312) 321-5156
Erin Butler
Executive Director
[email protected]
Vince Leibold
Operations and Administration
[email protected]
Perry Juliano
Event Services
[email protected]
Megan Laatsch
Education and Learning Services
[email protected]
Rebecca Baker
Exhibits and Sponsorship
[email protected]
Jennifer Snider
Marketing and Communications
[email protected]
Tissy Greene
Membership Manager
[email protected]
Movers and Shakers
Coming to AmSECT Today!
Movers and Shakers is your space for passing on professional
news to the perfusion community. Share promotions and job changes
with all of us starting with the March/April issue of AmSECT Today.
Send your news to the Editor
[email protected]
amsectu.org
American Society of
ExtraCorporeal Technology
OFFICERS
President: Jeffrey B. Riley MHPE CCT CCP
President-Elect: Kenneth G. Shann CCP
Treasurer: Robert C. Groom CCP
Secretary: Susan J. Englert RN CCP CPBMT
BOARD OF DIRECTORS
ZONE 1
Cory M. Alwardt PhD CCP
George Putnam CCP RRT RCP
AK, AZ, CA, CO, HI, ID, MT, NV, NM, OR, UT, WA, WY
ZONE 2
Charles Johnson RN CCP FPP
Robert D. Longenecker BS CCT LCP CCP
AR, IL, IA, KS, LA, MN, MO, NE, ND, OK, SD, TX, WI
ZONE 3
Theron A. Paugh CCP
William Scott Snider CCP
AL, FL, GA, IN, KY, MI, MS, OH, TN, PR
ZONE 4
Ian R. Shearer BS CCP
John R. St. Onge CCP
CT, DE, DC, ME, MD, MA, NH, NJ, NY, NC, PA,
RI, SC, VT, VA, WV
NEWSLETTER CONTRIBUTORS
EDITOR-IN-CHIEF
Thomas B. Rusk CCP
[email protected]
COLUMN AUTHORS
Shahna L. Bronson CCP
Stacy Bllythe RN PhD
Isaac Chinnappan MS CCP LCP FPP CPBMT
Kellen Goldberg MPS CCP
Mat Medlin RRT BS CCP LP
Laura Rigg CCP
Jeffrey B. Riley MHPE CCTP CCP
INVITED AUTHORS
Gary Grist RN CCP Retired
STUDENT AUTHORS
Brent Thye
AmSECT
oday
© Copyright 2016 AmSECT. AmSECT Today is
published six times a year by the American Society
of ExtraCorporeal Technology, 330 N. Wabash Ave.
Suite 2000, Chicago, IL 60611. All rights reserved.
Direct address changes, manuscripts, photographs
and inquiries about editorial matters to Editor, AmSECT
National Headquarters, 330 N. Wabash Ave. Suite
2000, Chicago, IL 60611.
Advertising rates and related details are available
upon request by contacting the above address,
emailing [email protected] or calling (312) 3215156. AmSECT reserves the right to accept or reject
advertising.
Annual membership dues include subscriptions to
AmSECT Today and to the quarterly publication, the
Journal of ExtraCorporeal Technology.
Opinions expressed in AmSECT Today are not
necessarily those of AmSECT.
THEME AR TIC LE
Safe ECMO Transport
By Mat Medlin RRT BS CCP LP
Savannah, Georgia
There are several challenges facing the interfacility transport
service contemplating transportation of a patient on ECMO. Factors that must be considered include the likelihood of successful
transportation with positive patient outcome, team composition and
safety considerations for transport.
Most institutions that initiate ECMO are more than capable of
fully caring for patients in their current settings. Reasons for transport
include suboptimal cardiothoracic physician staffing, centers that
are not capable of initiating VAD therapies in the patient who has
Mat Medlin RRT BS CCP LP
failed to wean and institutions that do not have cardiac transplant
capabilities. One must quickly realize that this cardiac patient is extremely ill and may not survive an
interfacility transport. The team providing transportation will have limited input into patient stability for
transport, since the patient has been stabilized to the highest extent possible and usually requires
therapies above those of the referring institution.
The transport team does have a say in the manner and nature in which the transport team is
configured. Because of the clinical instability of the patient and the complexity of the ECMO apparatus, it is appropriate to augment the transport team with additional staff to ensure the highest
likelihood of a safe transport with positive patient outcome. Staff may include:
• Cardiothoracic surgical MD or physician assistant (PA). Due to the inherent risk of exsanguination in the event of an inadvertent decannulation, it is appropriate for a cardiothoracic
surgical MD or PA to accompany the patient on the transport.
• Certified clinical perfusionist (CCP). The perfusionist is responsible for the safe operation
and troubleshooting of the ECMO apparatus. Regardless of the transport nurse’s comfort
level with ECMO, a CCP should always be part of an ECMO transport team.
• Anesthesiologist or certified registered nurse anesthetist (CRNA). Anesthesia professionals are extremely familiar with the unique airway, oxygenation and ventilation needs of the
ECMO patient. The anesthesiologist and/or CRNA are also very involved in circulatory
support of the patient.
• Additional lifting assistance. If available, an additional ambulance crew should be detailed
to assist in physical movement of the patient and equipment, as this task can be cumbersome for clinical staff alone.
In addition to team composition, the transporting team has the ultimate say and responsibility
for safely transporting the patient from the referring facility to the receiving facility. Teams that are
already prepared for or accustomed to transporting isolettes, IABPs and VADs may have an easier
time transporting the ECMO patient without advanced warning or preparation. In general, these
agencies are used to working with non-transport clinicians and have a general understanding of safe
transport of such devices. The transporting agency must remember that the ECMO apparatus is
generally larger than a transport VAD, but may be as large as a full-size non-transport VAD console.
The physical size and weight of the ECMO apparatus may be its only limiting factor for safe transport.
Vehicles equipped with hydraulic lifts and floor-mounted attachment points, commonly referred to
as Bucher mounts, are preferred, as these features assist in safely lifting and securing the ECMO
apparatus. It is critical that all devices introduced into the rear of the ambulance be strapped in place
to prevent inadvertent movement during transport. This will provide a safer environment for both the
patient and medical staff in the ambulance.
Once the decision has been made to transport an ECMO patient and the vehicle and team
have been identified, the task at hand becomes safely preparing the patient for transport. As noted
earlier, these patients are extremely ill and may require multiple vasopressor agents and blood
products to maintain adequate hemodynamics. IV infusions should be triaged, and those deemed
non-essential for transport or that can be converted to IV push should be discontinued for the sake
of space. Depending on the transport time, remaining IV infusions may either be left on the current
infusion pumps, if they can be safely secured, or switched to smaller transport infusion pumps.
All IV lines and sites should be labeled and secured. Appropriate monitoring includes arterial and
T HE M E A R T I C L E
central venous pressures, continuous end-tidal CO2 and cardiac rhythm
monitoring, non-invasive blood pressure and continuous core temperature.
Confirm that all ECMO venous and arterial return lines are secure by suture
or other method. Evaluate surgical and arterial sites for bleeding regularly
and after each move. The perfusionist should remove all non-essential
components of the ECMO console to reduce the size and weight. Once
completely prepared for movement, the patient should be moved to the
EMS stretcher with as much staff assistance as possible and secured with
a minimum of three stretcher straps. All required surgical instruments and
suture material should be acquired by and accompany the cardiothoracic
surgical MD or PA, as inadvertent decannulation would be disastrous.
The patient on ECMO is one of the most complex and unstable
patients the transport team will encounter while performing critical care
transport. As most requests are unscheduled, transport teams should
work closely with referral centers to identify what is needed to complete
a transfer in a timely manner. Services and referral centers should also
participate in “dry run” exercises and perform after-action critiques with
a focus on safety. Transport services should predetermine vehicles that
meet the requirements for completing such a transfer and train their staff
to properly secure the ECMO apparatus in these vehicles.
Page 5
ANNUAL CORPORATE MEETING
MEMBERSHIP ANNOUNCEMENT
The Annual Corporate Meeting for
Membership of the American Society
of ExtraCorporeal Technology will take
place Friday, March 18 at 4:30 pm MT in conjunction
with AmSECT’s 54th International Conference at the
Broadmoor Resort, Colorado Springs, Colorado.
Join your colleagues to hear:
•
•
•
•
•
•
President’s Address
State of the Society
Election Results
2016 Strategic Plan
Treasurer’s Report
New Business
WELCOME NEW MEMBERS
Active
Reginald Ballard CCP.........................................................Alexandria, VA
For more information and to register, visit
www.amsect.org
Katie M. Bertrand CCP.......................................................... Houston, TX
Kathryn G. DeAngelis CCP MHA..................................... Philadelphia, PA
Dorothy A. Garbin CCP..................................................... Little Rock, AR
Timothy Snook CCP.............................................................Westfield, NJ
2016 AmSECT Today Themes
Associate
Aaron Splint BS...................................................................Falmouth, ME
International
Sandra S. Gibb CCP........................................St. Andrews, MB, Canada
Student
Melat Bikila....................................................................UPMC Shadyside
January/February Extended Life Support - Transport Medicine
AmSECT International Conference Promotion March/AprilPharmacology - Myocardial Preservation
AmSECT International Conference May/June
Pediatric and Congenital Perfusion
Quality and Outcomes Conference Promotion
July/August
New Advances in Blood Management /
Best Practices in Perfusion
AmSECT International Conference Photos/
Summary
Quality and Outcomes Conference Promotion
September/
October
Professionalism - Perfusion Education Adjunctive/Ancillary Perfusion Responsibilities
Ashley Densmore..........................................................UPMC Shadyside
John Englert.....................................................................Rush University
Lindsay Hayes...............................................................UPMC Shadyside
Joseph Holquist................................................................Rush University
Kevin Hulbert................................... Medical University of South Carolina
Nhuha Huynh.................................................................UPMC Shadyside
Donna M. Lenkiewicz.......................................................Rush University
Jacob McNinch.....................................SUNY Upstate Medical University
Chad C. Panick..............................................................UPMC Shadyside
Stephen Prono CST.........................................................Barry University
Allison Rowden................................ Medical University of South Carolina
Marguerite Wellstein.............................Milwaukee School of Engineering
November/
Emergency Preparedness - Emerging
DecemberTechnology
Quality and Outcomes Summary
A m S E C T MANAGEMENT C HANGE
New AmSECT Office Open for Business in Chicago
Meet your Headquarters Team!
Dear Members,
The American Society of ExtraCorporeal Technology (AmSECT) is pleased to announce that we are officially open for business in our
new Chicago, Illinois office.
Our new headquarters staff is excited about working with AmSECT members and is eager to be of service. Our new contact information is:
American Society of ExtraCorporeal Technology (AmSECT)
330 N. Wabash Ave., Suite 2000 | Chicago, IL 60611
Phone: (312) 321-5156 | FAX: (312) 673-6656 | Email: [email protected]
Websites: www.amsect.org, www.amsectu.org
If you have any questions, please reach out to your new staff team:
NAME
TITLE
E-MAIL
Erin Butler
Executive Director
[email protected]
Vince Leibold
Operations and Administration
[email protected]
Perry Juliano
Event Services
[email protected]
Megan Laatsch
Education and Learning Services
[email protected]
Rebecca Baker
Exhibits and Sponsorship
[email protected]
Jennifer Snider
Marketing and Communications
[email protected]
Tissy Greene
Membership Manager
[email protected]
Certain inquiries may require research on the part of our new staff members during this transition period. However, rest assured the
staff will do their utmost to get an answer to all of your questions as quickly as possible.
The AmSECT Board of Directors is thrilled to welcome our new staff team and open our new offices. This truly marks a new day
at AmSECT. We have the highest confidence that the management team will be diligent partners in helping the board advance
AmSECT’s mission and, most importantly, they will serve you to provide the best membership experience possible.
Thank you for your continued membership and support.
Sincerely,
President
Page 7
A m S E C T N AT IONAL AWAR DS NOMINEES
AmSECT Announces 2016 National Awards Nominees
AmSECT’s Achievement Recognition Committee and Board of Directors are pleased to announce
those nominated by their peers for consideration as recipients of AmSECT’s 2016 National Awards.
Individuals are nominated by the AmSECT membership and selected by the board of directors.
The John H. Gibbon, Jr. Award is designed to honor a candidate making a significant
contribution to the cardiopulmonary discipline
interrelating with the field of extracorporeal
circulation. The significant contribution must
be in, or relate to, the field of extracorporeal
circulation, but the specialty of the candidate is
not a criterion for the award. The candidate may
receive the award only once. The award consists
of a medal and a check in the amount of $1,000.
The Perfusionist of the Year Award is
presented annually to a perfusionist making
significant contributions to the field of extracorporeal technology. The award consists of
a plaque and a check in the amount of $1,000.
The Perfusionist of the Year Award is sponsored
by Medtronic, Inc.
The Gibbon Award
2016 Nominees
Ashley B. Hodge MBA CCP FPP
Nationwide Children’s Hospital
Cynthia P. Cervantes CCP
Barry University
Barry University
Pedro J. del Nido MD
Boston Children’s Hospital
William J. DeBois CCP MBA
New York Presbyterian Hospital
Perfusionist of the
Year 2016 Nominees
The Award of Excellence is presented
annually to a perfusionist who demonstrates
that work of excellence which best exemplifies
creativity and intellectual honesty in perfusion.
The award is presented in any area such as
education, continuing education, research,
publication or leadership. Sponsored by The
Wood Insurance Group, the award consists of
a plaque and a check in the amount of $1,000.
Award of Excellence
2016 Nominees
Michelle S. Benson CCP
University of Colorado Hospital
Barry University
William J. DeBois CCP MBA
New York Presbyterian Hospital
Craig R. Vocelka CCP MDiv
University of Washington
Susan J. Englert RN CCP CPBMT
President, Perfusion Services LLC
Dawn M. Oles MHPE CCP LP
Mayo Clinic
v
The recipients of AmSECT’s National Awards will be announced at the National Awards
Luncheon on Thursday, March 17 during AmSECT’s 54th International Conference at The
Broadmoor Resort in Colorado Springs, Colorado. Conference and hotel information can
be found at www.amsect.org/p/cm/ld/fid=1203. Recipients for 2016 will prepare a brief
acknowledgement of acceptance. The winner of the Gibbon Award will present a more
in-depth talk about his or her work as it relates to the field of perfusion.
It is indeed an honor to be recognized as an outstanding professional from among a
membership of more than 2,000. Their excellence in extracorporeal technology activities
is a shining example to us all. Please join AmSECT’s Board of Directors and the Achievement Recognition Committee in wishing heartfelt congratulations to all of the nominees.
v
* * * * * ******* A m SE CT 2016 C ANDIDATE S ******** * *
AmSECT Online Ballot Open January 17, 2016 - February 6, 2016
Voting for the 2016 slate of officers and committee members will take place online. Ballots are password-protected in the Members Only section of
www.amsect.org. The following members have submitted Willingness to Serve applications for vacant AmSECT volunteer leadership positions. Each
candidate has been screened by the nominations committee and has been determined to meet eligibility requirements. Winners will be announced at
the Annual Corporate Meeting for Membership on Friday, March 18 during AmSECT’s 54th International Conference in Colorado Springs.
President-Elect
William J. DeBois
Biographical Statement: I have been
an active perfusionist for over 30 years.
AmSECT had been an integral part of my professional career. As an AmSECT member,I
have served on the Executive Board as
Secretary, as Zone Director, and as Chair
of the Conference Planning Committee. As
CPC Chair, our team made the International
Conference the largest perfusion meetings
for in terms of attendance and profitability
as well as receiving excellent evaluations for
content from the attendees. This in turn led to the abilityof AmSECT to offer
innovative opportunities such as simulation, student education, interactive audience participation and translational research. I continue to be a highly engaged
professional and was awarded the Gibbon Award and other research awards
for contributions to safety, blood conservation and performance improvement.
As president of the New York State Society of Perfusionists, I helped to lead
our state to passage of perfusion licensure legislation.
Interest in Running: I feel a responsibility to help serve the largest
professional society of perfusionists. AmSECT should be a more valuable
resource to our profession. I believe that a more collaborative approach
to other societies, both national and international, will allow for better
information sharing. The result of which will lead to better patient care.
We need to find ways to improve society membership. This could include
the formation of regional societies, web-based meetings and increased
involvement and support of perfusion education programs. Respect is an
issue with our profession. We need to support each other and have an
organization that promotes this. AmSECT should develop programs that
recognizes our members on a more local level — our unsung heroes.
Further development of AmSECT University will help foster our organization as a valuable resource for perfusionists. I pledge to serve the society
and further improve this great profession of ours. Thank you.
President-Elect
Benjamin Swanson
Biographical Statement: Education:
University of Nebraska Medical Center
Masters in Perfusion Science. Work
Experience - Perfusionist, Clinical Instructor, University of Kansas Hospital Center for
Advanced Heart Care. Teaching Experience
- Adjunct Professor, University of Nebraska
Medical Center, Clinical Perfusion Education.
AmSECT Service - Chairman of Bylaws
Committee, International Conference planning committee, AmSECT University Dean - College of Perioperative Services.
Interest in Running: I am running for President-Elect because I
believe in the importance of our organization and its mission to serve the
perfusion community. My vision for AmSECT is twofold. One, to continue
to provide world class continuing education, which is practical and realtime data driven, whether it is through AmSECT University or one of our
national meetings. Second, make AmSECT’s standards and guidelines
an integral part of the decision making process within hospital perfusion
programs and administrative departments. I believe that through the collaboration of perfusion registries and the continued efforts of evidence
based medicine, best practices can be not only shared with the perfusion
community, but become standards of care within our entire healthcare
system. Big picture, hospital administrators will ask the question: Do we
follow the recommendations of AmSECT? I realize this is a huge undertaking however, I believe it essential to progression of our profession.
Secretary
James Reagor
Biographical Statement: Jim graduated from the University of Iowa in 1995
with a degree in Perfusion Technology and
later followed that up in 2014, with a Masters
in perfusion science from the University
of Nebraska. He is currently employed at
Cincinnati Children’s Hospital Medical Center
as the Director of Cardiovascular Perfusion.
Jim serves as AmSECT’s Government Relations Committee Region 2 Representative
and Co-Chairs the MCS Committee. He has served on AmSECT’s Board of
Directors as Secretary and Zone Director, the team leader for Heart Care
International’s perfusion team, President and Treasurer of the Oklahoma
Association of Certified Perfusionists, and the Vice-President of the Maryland
State Perfusion Society.
Interest in Running: In these times of economic uncertainty, changes
to healthcare reimbursement and the wellbeing of future generations, it is
necessary to secure and strengthen our profession. This can be done by
serving the members of AmSECT. Societies exist to serve their members
and provide a voice on a national level. AmSECT is the national voice of
perfusionists and with patient safety as a foundation perfusionists should
expect to have the support of their national society. To that end, as Secretary I will work within AmSECT to create new tools, improve old systems
and develop member benefits that aid the practicing perfusionist, improve
outcomes for our patients and support our scope of practice.
Page 9
* * * * * ******* A m SE CT 2016 C ANDIDATE S ******** * *
Secretary
Bylaws Committee
Craig Vocelka
Biographical Statement: I have
held numerous positions in the Society.
Professionally I received my formal perfusion training at the Texas Heart Institute in
1975 and have been learning ever since. I
am currently the chief of perfusion services
at the University of Washington (Seattle)
where I work with an amazing staff of 11
other perfusionists covering 4 hospitals
and all aspects of patient care involving our
expertise. I have a bachelor’s degree from the University of St Thomas in
Houston and a master’s degree from Seattle University. I am married to
Victoria and our daughter Sheri and her husband Chris have blessed us
with two wonderful grandsons.
Interest in Running: Bylaws committee - A society’s bylaws are the
foundation upon which the organization functions. For whatever reason,
I have studied our bylaws and understand them. It would be an honor to
serve AmSECT in this role.
Secretary - As you recently read, AmSECT has completed the transition of changing management firms. I feel with my experience in AmSECT,
I can function as a resource in making sure that our new partners, SmithBucklin, have an understanding of the history, our great accomplishments
as well as the mistakes we have made, as we move forward to rejuvenate
and improve the Society. This is a pivotal time in the history of AmSECT,
and I truly believe that we need a balance of new, fresh faces and ideas
as well as leaders with experience. As excited as I am to see that we have
new people getting involved, I feel there is benefit to having someone with
experience to serve on the leadership team at this point in our AmSECT
journey. I ask for your support as we work together to make AmSECT a
resource for all involved in extracorporeal circulation.
Treasurer
Ethics Committee
Renee Axdorff-Dickey
in promoting and improving professionalism for perfusionists worldwide.
In 2011, I stepped down as Chief at Children’s to pursue a degree in
business administration, because I saw a need to connect the business
of medicine to the clinical side. I began a masters program at Seattle
University, receiving a Healthcare Leadership Executive MBA in 2013. I
have made an impact serving on two other non-profit boards in the Seattle area. As Treasurer of AmSECT, I will bring the ability to understand
financial reports and communicate financial concepts clearly, help create
a successful budget, and keep an eye on the long term to make sure we
have the resources to meet the challenges that lie ahead.
Treasurer
Scott Snider
Biographical Statement: I’ve been
fortunate to work with many talented coworkers and friends for the last 20 years.
I was trained at THI in 1995. Since then,
I’ve been employed in large systems such
as the Cleveland Clinic Foundation and
Duke University Hospital, and in the small
teams of community hospitals in Ohio and
Virginia. I’ve been an AmSECT member for
10 years. Ddirector for the last 3 years and as
a member and chairman of Perfusion Without
Borders for 6 years. I am a member of the AmSECT safety committee. I have
also been an editorial assistant and reviewer for our scientific journal, JECT.
Outside of AmSECT, I am a perfusion representative for the missions group,
CardioStart, and a chairman for their planning committee. I have been married
for 18 years and have four wonderful children, ages 5 to 16.
Interest in Running: Outside of my work setting, where I’ve been
privileged to join with the strongest team of perfusionists and the most
talented and professional doctors, surgeons and nurses that I’ve ever met,
the second most influential experience in my career has been serving as
a representative for your AmSECT Board of Directors. This opportunity
has enabled me to work with and learn from some of the most motivated
leaders in our field. These volunteers offer their talents with humility and
for no other reason than to preserve the professional character of our
practice. Today, AmSECT is positioned as never before to overcome the
hurdles of a changing healthcare landscape and advance the standards
of our profession into the future. With that in mind, I ask for the opportunity
to continue my service as your next Treasurer, to safeguard the principles
of our society and to protect your investment in our career.
Biographical Statement: I graduated
from the Medical University of South Carolina in 1988 and began my career as a perfusionist at Yale New Haven Hospital. After a
year there, I headed to Seattle, Washington,
where I worked for a year at Sisters of Providence Hospital. In 1990, I was recruited by
Tammy Haga-Greco
one of the surgeons at Seattle Children’s to
join the small pediatric perfusion team there.
When I was made Chief in 2004, I had the
from the Medical University of South Caroopportunity to transform the department into
lina’s perfusion program in 1992. Since that
a thoroughly modern pediatric perfusion program, using the latest equipment
time, I have worked in St. Louis, Missouri
and procedures. I worked with our team to continuously improve techniques
primarily as a pediatric perfusionist. From
and results, making advances in patient outcomes, and working with others
1992-1994, while I was working on my CCP,
on the heart team to publish the results of our efforts. Last year our program
I did both adult and pediatric patients. Since
became a clinical site for students from MUSC and Midwestern University.
1996, I have worked primarily in a children’s
Interest in Running: AmSECT has helped me in my career, and I
hospital and the adult patients I see are adult
want to pay it forward and continue the work that our society has done
congenital cases. At present, I work for Saint
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Director Zone 2
* * * * * ******* A m SECT 2016 C ANDIDATE S ******** * *
Continued from page 9
Louis University at Cardinal Glennon Children’s Medical Center. In my current
position, I would say my job description is whatever rolls through the door...
ECMO, CPB, VAD, transplant, transport ECMO with the addition of education for other healthcare providers through the academic program(s) at SLU.
Interest in Running: I have been a member of AmSECT since 1992
when Jeff Riley, our program director, made us all sign up as students.
I have watched AmSECT transition through the decades from regional
representation to zoned representation. It has been exciting to see the
addition of the improved website with the mobile app as well as the continued support of our students and schools. As the outgoing President
for The Missouri Perfusion Society, I appreciate how difficult it is to get
your peers to volunteer. The job is demanding with call requirements and
extracurricular endeavors, but as my children have moved into the young
adult realm, I realize that this is a good time for me to give back to the
profession that has given so much to me. It would be an honor to represent
my Zone on a national level.
Director Zone 2
Robert Longenecker
Biographical Statement: I am a current AmSECT Board member from Zone
2 and have been an active perfusionist for
nearly 36 years. I am a 1980 graduate of
The Ohio State University. I’m currently the
Manager of Perfusion Services at Mercy
Hospital St. Louis, where I have been employed since 1984. My wife Mary and I live
in Chesterfield, Missouri, a St. Louis suburb.
We have been married for 32 years and have
2 grown daughters. Perfusion has been a
terrific and rewarding profession for me, and I have always felt compelled
to be actively engaged in our profession. I was a founding member of The
Missouri Perfusion Society, becoming its first president. I lead the successful
campaign to license our profession in Missouri in 1997, becoming the third
state with perfusionist licensure. I am proud to be a continuous member of
AmSECT since my student days in the late 1970s.
Interest in Running: I am a very strong believer in professional
stewardship. I have supported my state society for 20 years. I served
on AmSECT’s government relations committee for 13 years, the last 4
serving as chairman. During the past 2 1/2 years I have been a Board
member our organization has accomplished much. We launched AmSECT
University, engaged in the implementation of an ambitious strategic plan
and have just completed an RFP process for a new management firm.
Our bylaws permit a Board member to serve a second term, and I would
like to do just that. This has been tremendously rewarding; I feel my past
experience will be an asset in the next 3 years. Many Board and Officer
positions will be new, and I hope to bring continuity to the tremendous work
ahead with our new management company. I’ll be dedicated in helping
our fine society prosper.
Director Zone 2
Kirti Patel
Biographical Statement: Educational
& Job Experience: A Perfusionist for almost
17 years and in healthcare for 23, I am a
graduate of The Texas Heart Institute. My
past experiences include positions as an
instructor at Texas Heart Institute, faculty
position at MUSC, staff perfusionist at Memorial Hermann Baptist Hospital and currently
as a Program Director for UTHealth Medical
School Cardiovascular Perfusion Program.
I have a BS in medical technology, Masters in Public Health and a Masters
in Perfusion Sciences. AmSECT Experience: 2008-2015 AmSECT Today,
Editor-in-Chief; 2009-2010 International Conference Planning Committee
Member; 2007-2008 Strategic Planning Committee; 2007-2008 AmSECT
Today, Associate Editor; 2006-2008 International Conference Planning
Committee Member; 2006-2007 Membership Committee Member; 20052006 Achievement Recognition Committee Chair; 2003-2007 Achievement
Recognition Committee Member; 2001-2015 AmSECT Today Contributor.
Interest in Running: I stand firm in AmSECT’s purpose and believe
that all of us owe gratitude for the societal contribution it has made on our
profession. I believe that AmSECT is developing into a better and more
improved organization that each of us should be proud of. It is my goal
to convince each perfusionist that AmSECT is vital to our own future
and that our profession cannot survive without such a society. Fifteen
consecutive years as a volunteer, my belief in the new direction of the
organization and my willingness to listen to all input for the betterment of
the organization make me the ideal advocate for this position. My major
objectives as your zone director would be to support the existing needs
of AmSECT and to actively contribute to the needs of its membership. I
will do my best to serve the interest of all perfusionists.
Director Zone 3
Daniel Gomez
Biographical Statement: I am a
graduate in Medical Technology (Southern
Illinois University) in 1992 and Perfusion
Technology (St. Louis University) in 1995.
I have been a staff perfusionist at St. Louis
Children’s Hospital & Children’s Hospital of
Philadelphia. Positions held at Nationwide
Children¹s Hospital have been CoordinatorECMO, chief-Mechanical Research andSupport and currently as chief, Perfusion
Services for the past 4 years. I have been a member of AmSECT since
1994 and served on the AmSECT Nominating Committee as a member and
chair from 2000-03. I have presented lectures at the AmSECT International
& Pediatric meeting in 2000, 2001, 2002, 2005, 2007 & 2012, AmSECT
sponsored-Perfusion Safety and Best Practices in 2008 and 2010.
Interest in Running: I am running for Zone 3 director to be a part of
the enthusiasm and vision the AmSECT board of directors has set for the
future of our professional society. The strategic plan gives its members a
clear view of the BOD intentions. The transparency and open communication is warranted from its members. I know many members ask, “What
Page 11
* * * * * ******* A m SECT 2016 C ANDIDATE S ******* * * *
do we get for our dues?” This is a great step to show its members that
the BOD and its volunteers are hard at work for you. My time within the
profession, an active participant and member of AmSECT, qualifies for a
Director position. My willingness to be transparent and communicate our
accomplishments to its members is necessary in this Position.
Achievement Recognition
Committee
Bylaws Committee
Ethics Committee
Nominating Committee
Lisa McCune
with a Masters in Cardiovascular Science
from Midwestern University in 2010. I have
worked for a physician practice, contract perfusion and now as a hospital staff perfusionist
at Virginia Hospital Center. I was introduced
to our field while working as a Medical Technologist in Arizona. My first day shadowing,
after observing a routine AVR, I watched the
team prepare for a total artificial heart implant.
I was hooked. My enthusiasm for perfusion is what motivates me to become
involved with an AmSECT committee.
Interest in Running: Part of the mission of AmSECT is to provide
for the professional needs of the perfusion community. Since becoming
a student member I have utilized the many resources AmSECT affords:
continuing education, networking, and establishing best practices to name
a few. Volunteering to serve on a committee is a great way to give back to
our professional society and I look forward to providing my time and energy.
Committee
drive and desire to make a difference. What compels me is my interest to
see research being completed that impacts patients in positive ways. I feel
we are at the forefront of technology and improved patient care, and I would
be honored to be a part of recognizing others for their success in the field.
Committee
Jason Windle
Biographical Statement: Hello, I’m
Jason Windle. I have been working in
healthcare for twenty three years and as a
Perfusionist for 10 years. I’ve worked in adult
cardiac surgery for the first seven years of
my perfusion career, four of those as a solo
chief Perfusionist. The past three years have
been spent at the Batson Children’s hospital
of The University of Mississippi Medical
Center specializing in pediatric perfusion.
I also have worked as a locums perfusion
provider in Mississippi,Tennessee, Arkansas for adult perfusion and Georgia
for pediatric perfusion services. I hold state perfusion licensure in Tennessee,
Arkansas, and Georgia. I’ve been an AmSECT member since 2006, certified
by the American Board since 2006 and an Academy member also since 2006.
Interest in Running: I am running for achievement recognition committee member because I believe a membership to a group should be more
than just a transaction of credentials and dues. Any relationship requires a
certain level of commitment of time and effort in order for it to be of benefit
to the parties. I’m at a point in my life and career that pointless relationships
do nothing but waste my time. I’ve been a “paying” member long enough,
it’s passed time for some contribution to my relationship with AmSECT.
Bylaws Committee
Molly Hageman
Biographical Statement: Molly Hageman completed her undergraduate degrees
Chrysta Terenzi
in Biochemistry (BS) and Chemistry (BA)
from the University of Minnesota. She
Biographical Statement: My name is
attended perfusion school at Vanderbilt
Chrysta Terenzi and I am a graduate of the
University Medical Center’s Cardiovascular
C.W. Post Long Island University Perfusion
Perfusion Technology program. During
Program. During my time at school, I was
perfusion school Molly presented at several
elected class representative, and awarded
meetings (both poster and scientific) on ABOmost professional. I am currently approachincompatible heart transplants, a case report
ing my third year as a board-certified perfuon ECMO post MVR, and Ex Vivo Lung Perfusion. Molly graduated in May
sionist at New York Presbyterian Columbia
2014 from Vanderbilt and began working at Boston Children’s Hospital as a
Hospital and was selected to begin in the
pediatric and congenital perfusionist. Molly has helped develop three classes
pediatric perfusion department in March
for AmSECT University; Review Course-Perfusion Methodologies: Pediatrics
2016. As a student I was an AmSECT speaker, having given a presentation
I & II, and ABO-Incompatible Heart Transplants. She hopes to continue her
pertaining to Veno-Veno-Venous-Arterial ECMO. More recently, this past
collaboration with AmSECT and AmSECT University.
April I attended the AmSECT meeting in Tampa, and I am looking forward to
Interest in Running: Molly Hageman is requesting to be considered
attending this year’s meeting.
for
the
AmSECT Bylaws committee. New graduates are the next generation
Interest in Running: I am running for Achievement Recognition
in
perfusion.
As a new graduate myself, I believe that we should take a
Committee Member because I want to be more immersed in the decimore
active
role
in our societies and I think that it’s essential to understand
sion making of AmSECT. I think it’s important that we promote personal
the
interworking
of the society; such as the bylaws. As a recent graduate, I
accomplishments and milestones within the perfusion community. As I
can
bring
a
fresh
set of eyes and unique experiences to the Bylaws comprogress in my career at Columbia, it has enabled me to recognize all of
mittee
that
might
aid AmSECT as it continues to grow. I am a very well
the advances we take part in within the perfusion profession. I have the
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* * * * * ******* A m SECT 2016 C ANDIDATE S ******** * *
organized, detail-oriented individual that enjoys learning and taking on new
challenges. I also really enjoy perfusion and look to spread my enthusiasm
to others I meet. I have every intention of maintaining my active role within
the society, including involvement in other committees following my term
in the Bylaws committee, were I to be chosen as a committee member.
Bylaws Committee
Daniel Herbst
Biographical Statement: Since
graduating in 1995 at the Michener Institute
for Allied Health Sciences where I received
the Alec Thorpe academic achievement
award, I have had the opportunity and
good fortune to gain extensive experience
in both paediatric and adult extracorporeal
circulation procedures. I have also completed a Master Degree in Health Professions Education in 2011 at Maastricht
University where I graduated with honors. In the early part of my clinical
perfusion career, I developed a personal interest in anti-coagulation aspects of blood management. Current interests are more strongly related
to patient safety in perfusion practice. I am presently working as a clinical
perfusionist in Sherbrooke, Quebec, Canada, and look forward to becoming a more active member of AmSECT.
Interest in Running: By volunteering to serve this profession through
AmSECT, I hope to give back, at least in part, what this profession has
so freely given me.
Bylaws Committee
Emily Thunstrom
Biographical Statement: My name
is Emily Thunstrom. I have been a Perfusionist for three and a half years. I graduated May 2012 from the Cardiovascular
Perfusion Program at North Shore University Hospital with a Masters of Science
in Cardiovascular Perfusion. I started my
Perfusion career at University of California
Los Angeles, UCLA, Medical Center. I
worked there for 10 months and then I
returned to New York to work at New York Presbyterian Hospital - Columbia
Campus. I remain at Columbia and have been the Chief Preceptor since
the beginning of the year. As a student, I was a member of the American
Society of Extracorporeal Technology, AmSECT. This past year I was able
to attend the annual meeting and renew my membership.
Interest in Running: Recognizing I am in the infancy of my career,
I am passionate about my occupation and am committed to its growth. I
would like to take part in the future of Perfusion, and I believe that AmSECT
is a great organization that can help me in pursuing that aspiration. I would
like to serve on the Bylaws Committee. I feel that being young in the field,
as well as working at a busy hospital with exposure to many different areas
of perfusion, would be beneficial for this position. I believe the bylaws
committee is an area that can help in determining where the future of this
profession can be heading. I look forward to the opportunity to participate
in the Bylaws Committee. I am excited about working closely with my
esteemed colleagues and to give back to the Perfusion community. Thank
you for your consideration.
Mikaela Allen
Biographical Statement: Education:
The Ohio State University, Bachelors of
Science in Circulation Technology(2008)
EduQual United Kingdom, PGD in Healthcare Management and Leadership (2015)
Perfusion Employment History: Georgetown
University Hospital - Washington, DC (with
HCSG mid-atlantic region travel to 7 hospitals) 2008-2013 Washington Hospital Center
per diem ECMO coverage - Washington, DC
2012-2013 Cleveland Clinic - Cleveland Ohio 2013-2015 Cleveland Clinic Abu
Dhabi - Abu Dhabi, UAE 2015 - present AmSECT Experience: - Meeting Attendance - 2008 Student Presentation on Heparin Induced Thrombocytopenia
and Thrombosis - Current Membership.
Interest in Running: I feel inclined to volunteer with AmSECT as a
means of humbly serving the perfusion community in a new way and to
maintain a close-knit relationship with our American perfusion colleagues.
My family and I recently moved to the Middle East – away from everything
that we know. Living so far away could make anyone feel isolated. Which
makes staying rooted personally and professionally extremely important to
us. I also realize that I have so much room to learn and grow professionally
,and would love to channel the wisdom of my peers and predecessors while
serving in a medical missionary capacity of sorts abroad. In my new role
I have grown to further appreciate the American standards of perfusion
services, and I would like to serve while remaining closely connected to
the perfusion community that I immensely respect.
John Lombardi
Biographical Statement: My first
exposure to Perfusion occurred in the animal
lab at Ohio State University. I was working
as a Research Assistant for the Division of
Transplantation at Ohio State. One of my
colleagues was in the Circulation Technology program at Ohio State and invited me
to observe a lab. From that first moment, I
was hooked! I graduated from the Perfusion
program at Ohio State University in 1996. My
first job was with TriHealth in Cincinnati. In 1998 I accepted a staff position
at Cincinnati Children’s Hospital. Currently, I am the Associate Director of
Perfusion at Cincinnati Children’s Hospital. Having a leadership role has given
me an enhanced perspective on the work required to maintain a successful
department. I have witnessed many changes within the field: better patient
monitoring, improved Point of Care devices, more sophisticated mechanical assist devices, transition to an electronic medical record and higher acuity cases.
Interest in Running: My involvement with AmSECT has been to
pay my dues and attend various meetings, leaving the tasks associated
with maintaining a professional society to others. Being a Perfusionist has
been an extremely rewarding experience. I am motivated to give back to
our profession. As a starting point, I wish to serve AmSECT as a member
of the Nominating Committee.
Page 13
F R O M M Y TIME IN THE TR ENC HES
What Will You Do After Your Perfusion Career Ends?
By Gary Grist RN CCP Retired and Stacy Bllythe RN PhD
I retired in December 2014. Prior to retirement, I was an active clinician, educator and researcher of perfusion. In this context, I was afforded
many opportunities to contribute to the field of perfusion including multiple
invitations to share my version of Oxygen Pressure Field Theory as it
relates to perfusion. As a retiree, I ceased to be clinically active or officially
associated with a perfusion program. However, I still felt that I had things
to offer the perfusion profession. In order to share my knowledge and
experience, I started a free educational website. This website provides a
platform for the Oxygen Pressure Field Theory that is easily accessible by
perfusionists, perfusion students, ECMO clinicians and any other critical
care providers who are interested. The site also contains a blog that has
articles about other important aspects of perfusion practice. For a time,
this was my way to contribute to the profession in retirement.
Throughout my career, I have been an ardent advocate for perfusion
safety. When Jeff Riley, the current AmSECT president, restarted the
safety committee, I became a member. My specific task was to develop
a safety program with emphasis on Failure Modes and Effects Analysis
(FMEA). FMEA is a proactive risk assessment technique that is endorsed
by The Joint Commission, the Centers for Medicare and Medicaid Services
and many patient safety organizations. FMEA for perfusion practice was
first described in an article by Wehrli-Veit, Riley and Austin*. Generally,
FMEAs are supposed to be written by a group of experts in the field who
arrive at a consensus about how a problem (or failure) can be prevented
or mitigated. The risks that patients have when exposed to these failures
are also quantified using a Risk Priority Number (RPN). The RPN is not a
statistical value, but a subjective value derived from the collective experience of the expert perfusionists. The RPN identifies the most dangerous
risks so that perfusionists can focus scarce resources to reduce those risks.
In order to fulfill my mandate, I needed to identify a group of expert
perfusionists to provide input on this project. An obvious starting point was
the other safety committee members. However, as they were all clinically
active, their time was significantly limited. Passionate about perfusion
safety and committed to my task, I began to think outside the box. As I
reflected on my own experience as a recent retiree and my desire to continue to contribute, I concluded that there must be other retired perfusionists
who would like to do the same but did not know how. So I put out a call
on PerfList for retired perfusionists to consult on FMEAs. The project was
described as volunteer, with no compensation other than the satisfaction
of knowing that their experience and wisdom as a perfusionist could still
provide a valuable resource to improve the perfusion profession. I had
my first volunteer within five minutes. Currently, there are 12 retired or
nearly-retired perfusionsts contributing to the project. There is no formal
limit as to how many can contribute.
Retirement marks a lifetime of achievement. While it may coincide
with physical decline, it does not necessarily indicate mental or intellectual
decline. Rather, retired perfusionists have a depth of experience and
wisdom that they can contribute if they are asked specific questions about
perfusion problems that need solving. Drawing on this wealth of knowledge
not only benefits the field of perfusion, but retired perfusionists themselves.
Below are comments from three of the
retired FMEA review perfusionists.
“Sometimes, some of us are convinced that we are done with the profession and then something like the FMEAs
comes along and you realize that you are
still in love with perfusion and simply don’t
let go. It is a great feeling knowing that you
can still contribute somewhat, but without
the stress.”
~ Marta Alvarez
Gary Grist RN CCP Retired
“I retired years ago due to a medical situation. So, what do you do,
as you have spent the most of your life as a perfusionist (1974-2006)? I
was very lucky. A couple of years before I was discharged from my life as
a full-time perfusionist, I was asked if I could help out at the neighboring
cancer hospital doing isolated limb perfusion (ILP) once a week, at most.
I said that I could help out during my spare time. And so I did. And, lucky
again, after a few years, I was asked if I could help out in the neighboring
OR. They were just starting up hyperthermic intraperitoneal chemotherapy
(HIPEC), once or twice a week. I said yes, and I have not regretted the
decision ever. I have been doing HIPECs and ILPs from 2001 to 2014,
when I stopped, aged 68 years. Besides doing the HIPECs and ILPs, I
have been a member of the editorial advisory board of Perfusion magazine,
also since 2001, and am still enjoying that job. And, of course, I enjoy
being a member of the FEMA group. It keeps me remembering things I
thought I had forgotten!”
~ Thore Pedersen
“I think the hardest thing for me about retiring was the realization that
I had a cerebral storehouse of arcane information that very few people
have, that it had no application in the outside world and that I would start
losing it as soon as I walked out the door. The FMEA’s work some of those
data banks, and it feels good to both think about clinical situations and
contribute to the profession. Thanks for the opportunity to be involved.”
~ Nancy Achorn
If you are retired or approaching retirement and would like to continue
to contribute to the field of perfusion, perhaps you should consider becoming an FMEA reviewer. Or maybe you like to write and have stories or
insights to share here in AmSECT Today. If interested in either opportunity,
please contact me, [email protected] . Don’t let your experience
and wisdom retire just yet!
Reference:
*Wehrli-Veit M, Riley JB, Austin JW. A failure mode effect analysis on extracorporeal circuits for cardiopulmonary bypass. J Extra Corpor Technol. 2004
Dec;36(4):351-7.
Contact Tissy Green with your Membership Questions – [email protected]
BROKEN
HEARTS
Emerging Technology:
My First HeartMate 3 Experience
By Laura Rigg CCP
University of Rochester Medical Center
As a perfusionist in an academic
setting, I have the privilege of spending countless hours alongside eager
students. Each student brings new enthusiasm for our field and has the desire
to find out more.
While maintaining that excitement is
possible for a fortunate few, for many, life
gets in the way. The desire to change the
world becomes a desire to enjoy life, the
desire to understand more becomes the
Laura Rigg CCP
desire to get through your to-do list and
the desire to revolutionize the field becomes a desire for time away with
peace and quiet.
So, in an attempt to appeal to that perfusion student deep inside of
each of you, I’d like you to dig deep and reevaluate a prevailing practice
with me. This discussion won’t be an easy one. In the next few minutes,
I’m going to ask you to question what you have known, or thought you
have known, for years.
Let’s Talk Anticoagulation
You may or may not remember the first time you learned about
heparin and the activated clotting time (ACT). It was probably presented
to you as the time it takes for a clot to form. The unit of measurement is
seconds and the ACT made so much sense for knowing a general picture
of anticoagulation for cardiopulmonary bypass (CPB). You probably learned
the universal 480 seconds as being the safe level of anticoagulation and
that a baseline is somewhere around 100 seconds. This was the first
layer of the onion.
Next, you may have been under the guidance of a great teacher who
taught you, “oh, by the way, the ACT is inaccurate under a few conditions.”
You learned that hemodilution, thrombocytopenia, platelet dysfunction,
elevated d-dimers, temperature and fibrinogen levels1 may cause your
results to be skewed. The next layer of the onion was peeled away and
the ACT was a bit more pungent.
Finally, a few of you may have had someone illustrate the ACT lesson by comparing differing ACT machines. If you were one of these few,
you remember learning that the ACTs are not consistent or comparable
between different types of machines. The mechanics are different. Some
ACT machines will stop counting when the first strands of fibrin are detected, signaling the genesis of a clot. Other ACT machines will not stop
counting until a solid clot restricts its moving parts and pieces. Additionally,
different machines use different activators to encourage the formation of
clot and this may affect the result. This is the final layer of our metaphorical
onion that may lead us to the conclusion that the ACT just plain stinks.
Why then has it been used almost unanimously and trusted by
surgeons, perfusionists and anesthesiologists in cardiac surgery since
the 1980s? The ACT has some extremely convenient qualities. The ability of the ACT to be Point of Care (POC) makes it almost irreplaceable.
Possibly more compelling is the cost of the ACT; it is more practical than
most tests of anticoagulation. If a cardiac surgery center uses the same
device for every procedure, abides by a given ACT threshold for CPB and
keeps those qualities in mind that may skew their result, the surgery can
be economically conducted without concern.
This is all fine and good until traditional CPB anticoagulation meets
extracorporeal membrane oxygenation (ECMO). How is it best to regulate
ECMO anticoagulation? There are numbers suggesting that up to 50 percent
of ECMO patients experience some type of thromboembolic episode during
their ECMO run and the likelihood of these episodes increases linearly with
the duration of ECMO.2 Besides being some of the most common complications of ECMO, bleeding and thrombotic events were found to be directly
correlated with increased overall mortality.2
So, what are people doing? In 2013, a group of researchers from
Johns Hopkins University set out to log this information by surveying the
ECMO centers registered with the Extracorporeal Life Support Organization (ELSO). There were 116 respondents with 113 reporting that they are
measuring ACTs with an average goal range of 180-200 seconds. Of the
same 116 respondents, 109 are measuring aPTTs at some point. Of those
109, 41 (35 percent) measure every six to eight hours, which was the most
common interval found. Anti-Xa measurements are taken routinely or occasionally at 65 percent of those 116 centers. Lastly, thromboelastogram
(TEG) is utilized at 50 of the 116 centers.1
This survey seems to show that the average ECMO center is measuring several different markers of anticoagulation; but which test is best?
Let’s look at each.
APTT is a measure of the intrinsic and common pathways of coagulation (the same as the ACT). Different aPTT tests have different reagents
and are not comparable from one machine to another, and its results are
affected by hemodilution. The aPTT, while not correlating with the ACT,
has a moderate correlation with measures of heparin concentration. Most
commonly, those who measure aPTT for ECMO report 1.5-2.5x the control
value being their target range.3 There are differing opinions about this level
and Bates and Weitz said in their Clinician Update in Circulation that this
often leads to sub-therapeutic heparin dosing.
The Anti-Xa in contrast is a measure of heparin level. The assay
takes a known amount of factor Xa and adds it to the patients’ plasma to
bind any present heparin. This binding creates a colored compound. Any
remaining factor Xa can be quantified and consequently this allows the
heparin level in the sample to be quantified.3 This means that Anti-Xa is
a direct measure of heparin effect.2 Anti-Xa results are said to correlate
well with tests of heparin concentration. The typical goal for ECMO anticoagulation is a level between 0.3 and 0.7 IU/ml.1
This survey found that most commonly the ACT was guiding the
respondent’s heparin dosing.1 Almost every center is using more than one
type of measurement though. Why? It would be ideal to use each test to
confirm what your primary test is telling you and therefore have the most
complete and accurate picture of anticoagulation, right? Unfortunately,
more tests may equal more confusion. Let’s look at this predicament.
It is well documented that the ACT does not correlate well between
machines. Unfortunately, the ACT also does not correlate well with the
aPTT. Further, the ACT and the Anti-Xa do not correlate to one another.
On top of all of that, the aPTT and the Anti-Xa have proved to have only a
Page 15
BROKEN HEARTS
slightly better correlation to one another than either to the ACT.2 A 2013
study of these very phenomena found significantly more hemorrhagic complication in patients whose ACT and Anti-Xa were “excessively discordant.”
The study concluded that when ACTs were low but a periodic measure of
Anti-Xa was high there was excessive anticoagulation of the patient.4 This
indicates that something was causing the ACT to be inaccurate, while the
Anti-Xa was trending with true anticoagulation. A study that trialed heparin
guidance with Anti-Xa found that they gave fewer transfusions and had
reduced episodes of bleeding compared to their prior protocol of ACT driven
dosing.1 Although it is tempting to measure each of these values and use
those in collaboration to determine the global picture of anticoagulation,
their inconsistencies may cause more harm than help.
Is a change in ECMO anticoagulation management even feasible?
Timely results are important, money is a major influence and time is money.
Completing ACT at the bedside and yielding results within minutes may
not just be its saving grace but a true game changer. The aPTT and the
Anti-Xa are both laboratory run tests and the time for results of these may
vary. I personally spoke with the lab at my institution and their standard
is to have results reported within one hour from receiving a stat sample
and within four hours of receiving a standard sample.
Another driving force here, and one that will come into play in nearly
all hospital decisions, is cost. Money is a necessary evil and the concern
makes sense. Here are the numbers. Your average ACT runs $3 per test
while an aPTT ranges somewhere between $30 and $60 per test.5 An
Anti-Xa at our institution costs $81 per assay and the average TEG runs
about $154. I also learned that recombinant anti-thrombin III costs about
$7,000 per dose, but that’s beside the point. As you can see, the ACT is
markedly lower in cost than are the other options. If we were to work the
numbers with an aPTT or Anti-Xa measured every four hours in a 24-hour
period (assuming $45 for the aPTT) that would make their costs $270 and
$486 respectively. At the same interval, which is likely under estimating
the average sample frequency, the ACT would be $18. Let’s not forget
the incurred costs of transfusion. Our research has told us that transfusion
rates were higher when ACT was used to guide anticoagulation. According
to ABC News, a unit of red blood cells costs about $150. Other sources tell
us that FFP is about $60 and platelets can cost upwards of $500 a bag.
So costs may skyrocket once transfusion is factored in, not to mention
possibly avoidable risk of exposure.
This topic is a tough one. I’ve only just scratched the surface of
this issue. Yes, and believe me I know, there’s much more that goes into
changing something quite like this. There’s the comfort level and the learning curve of every provider involved. The inability to coordinate, calibrate
or validate a new testing method with the traditional ACT that you may
have used for years causes discomfort. The acceptance that bleeding and
clotting are expected and common complications on ECMO has allowed
many to avoid the topic altogether. There is so much information out there
about each of these tests. There are very few studies documented using
solely the Anti-Xa test for ECMO anticoagulation but the current information
is promising. In fact, a study out of South Korea just in September 2015
stated that the Anti-Factor Xa assay is one of the most accurate heparin
monitoring tests available.1 There are guidelines and suggestions from
ELSO and a 2014 study, both suggesting that a comprehensive protocol
is the way to go.2 It is important to be cognizant in this approach, which
tests are expected to correlate and what is known to be inconsistent.
Please remember to continue taking that “student-like” enthusiasm
to work with you each day. Leave complacency to someone else; you’d
be surprised at the problems you can solve!
References:
1. Bembea MM, Annich G, Rycus P, Oldenburg G, Berkowitz I, Pronovost P.
Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey. Pediatric Critical Care Medicine:
a journal of the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies. 2013;14(2):e77. doi:10.1097/
PCC.0b013e31827127e4.
2. Lequier L, Annich G, Al-Ibrahim O et al. ELSO Anticoagulation Guideline.
Extracorporeal Life Support Organization. 2014. Available at: http://www.
elso.org/Portals/0/Files/elsoanticoagulationguideline8-2014-table-contents.
pdf. Accessed December 28, 2015.
3. Oliver W. Anticoagulation and Coagulation Management for ECMO.
Seminars in Cardiothoracic and Vascular Anesthesia. 2009;13(3):154-175.
doi:10.1177/1089253209347384.
4. Bembea MM, Schwartz JM, Shah N, et al. Anticoagulation monitoring during
pediatric extracorporeal membrane oxygenation. ASAIO Journal (American
Society for Artificial Internal Organs : 1992). 2013;59(1):63-68. doi:10.1097/
MAT.0b013e318279854a.
5. Coughlin M, Bartlett R. Anticoagulation for Extracorporeal Life Support:
Direct Thr.: ASAIO Journal. LWW. 2015. Available at: http://journals.lww.
com/asaiojournal/Abstract/2015/11000/Anticoagulation_for_Extracorporeal_Life_Support__.6.aspx. Accessed December 29, 2015.
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Page 16 Viewpoint
ST U D E NT
An Experienced Perspective on Transport Medicine
By Brent Thye
Cleveland Clinic School of Cardiovascular Perfusion
My name is Brent Thye. I am a current perfusion student at the
Cleveland Clinic, and I’m graduating in May. The quandary of transport
medicine in perfusion is an interesting one and a realm in which I have
some experience. I worked for 10 years as a paramedic prior to “discovering” perfusion; five years in ground transport followed by five years in air
transport with two in management. I have seen the extremes of the field;
IABPs generally stop pumping when it’s -30 degrees and ambu bags and
other plastics start falling apart when it’s 120 degrees! The rarity and complexity of ECMO transports makes them an especially difficult proposition
requiring the expertise of a perfusionist.
To understand the intricacies of transport, let’s start with a quick primer.
There are four main service levels: Basic Life Support (BLS) which, as the
name implies, is very basic. Service providers are qualified to administer
oxygen and aspirin, and they rarely carry any drugs or continuous monitoring equipment. Advanced Life Support (ALS) involves a paramedic. The
vast majority of 911 ambulances are ALS level; they carry a basic drug kit
and cardiac monitor but cannot monitor invasive lines and rarely carry IV
pumps or ventilators. Critical Care Transport (CCT) utilizes a critical care
RN. They can monitor invasive lines and have ventilators and IV pumps.
The fourth level consists of specialty teams such as neonatal or ECMO
transports. These require additional staffing not normally available and
not all transport agencies are able to provide this service. I would always
ask for a CCT level of care as they are the most likely to possess the
resources needed if an ECMO team is not set up or available. Most CCT
programs are able to transport IABP patients but even that is a very low
frequency/high acuity ordeal. I have personally transported IABP patients
and can attest to the logistical nightmare that it is. I haven’t transported
any ECMO patients, but during the influenza epidemic, I transported a
number of pre-ECMO trainwrecks. These were always coming from a
small hospital to a tertiary care facility for ECMO placement. Frequently
physicians request to transport the patient in prone position but agencies
rarely have the ability to support that.
Next is the method of transport: ground ambulance is the most obvious, though not every ambulance is created equal. They range from vanstyle up to the size of semi-trucks. With the amount of equipment needed
for ECMO, always request something large. Many companies will not send
a large ambulance unless it is specifically requested! Fixed wing (airplane)
is the choice for long-distance but will always involve an ambulance ride
to/from the airport, which adds complexity. Rotor wing (helicopter) is usually the choice for intermediate distance and you generally only have to
load and unload the patient once. However, many times rotor wing isn’t
an option. The vast majority of flight companies utilize smaller aircraft to
save costs. This will often preclude taking a full crew because of weight
or space constraints.
Trust but Verify
When transport is called, it is likely because the patient is not stable.
Referring agencies will regularly paint a rosy picture only for the transport
team to arrive and find that things “have deteriorated” significantly from
what they were originally told. Be prepared
to switch them to your equipment but don’t
just run out with the patient. Stabilize them
on your circuit and send a blood gas to
make sure things are copacetic because
this is likely your last chance to correct any
placement issues. Once you leave, they
don’t want you coming back!
As with everything, the key to a successful transport is communication. Transport crews are tightly knit groups; make sure
Brent Thye
to coordinate and let them know what you
need and, more than likely, they can help. If you think you have to play
MacGyver in the OR, imagine piecing things together in the field. If it can
be done, they will figure it out. The most difficult parts of a transport are
always the loading and unloading processes. These movements are the
most susceptible to the pulling of lines, dropping of monitors and other
potentially catastrophic mishaps. Minimizing the number of patient movements will serve you well. Most teams are not used to lines that are literally
life and death so impart the importance of maintaining them!
Like all things in perfusion, you need to be prepared for the worst case
scenario: oxygen runs out, batteries die, IV pumps stop working, weather
moves in. Any other scenario that you can imagine has happened. You
would not believe the number of issues that will “ground” an aircraft and
force a change of plans. A point to remember, if you expect things to go
smoothly, you will be in for a very rough ride.
Expect Nothing and You Will Never Be
Disappointed
When things do go pear-shaped, you have to have a plan. Is CPR
an option? Can you support the patient with mechanical ventilation and
PEEP? How are you going to manage anti-coagulation? The list goes
on but you see the point. A more cerebral question is: Who ultimately is
responsible for the patient if things don’t go well? Is it the medical director
of the transporting service or is it the accepting surgeon? What are you
authorized to do under their respective licenses? Knowing this ahead
of time can keep you out from under the bus and hopefully out of court!
Which brings up documentation; if it wasn’t documented, it did not happen. An example is an endotracheal tube. When I had a tubed patient,
it was paramount to assess and document before and after any patient
movements and periodically thereafter. Confirmation should always be by
more than one method. It can be redundant, tedious and time-consuming
but this is the level of professionalism expected and necessary.
With a modicum of preparation and coordination an ECMO transport
can, and usually does, go smoothly. You have to know what resources you
have and where they are combined with practice runs to refine a transport
program. Making everything protocol-driven and consistent will improve
safety for both patients and providers. And do remember, calling someone
an ambulance driver is like reducing perfusionists to knob turners!
Page 17
Individualized Heparin Management:
Right for a Complex Environment.
Sicker patients, variable heparin potency, desire to reduce blood product usage—in today’s challenging
environment, Individualized Heparin Management with the HMS Plus System offers the visibility and
precision you need to deliver significantly different—and better outcomes—than using ACT alone.*
See why at medtronic.com/ihm
*Despotis GJ, et al. “The Impact of Heparin Concentration and Activated Clotting Time
Monitoring on Blood Conservation.” J Thorac Cardiov Sur, 1995, Vol 1 No 1: 46-54
UC201506806 EN © 2015 Medtronic, Inc. All Rights Reserved.
Page 18 ?
How much do you know about...
EXTENDED
LIFE
SUPPORT
Extended Life Support Quiz
By Isaac Chinnappan MS CCP LCP FPP CPBMT
Vanderbilt Children’s Hospital
1. Which of the following is true of Angiotensin II?
a. Selective mesenteric vasodilator
b. Production is due to pulsatile perfusion
c. a and b
d. None of the above
2. Inflammatory mediators cause which of the following?
a. Gut reperfusion injury
b. Mesenteric vasodilation
c. Mesenteric vasoconstriction
3. Endotoxemia can lead to __________.
a. Increased splanchnic perfusion
b. Bleeding
c. Metabolic alkalosis
d. Septic shock
4.
The Cori Cycle represents:
a. Cytochrome P450 system
b. Glucose production and lactate clearance
c. Synthesis of plasma proteins
d. Normal metabolic supply and demand
5. Kupffer cells are related to which of the following
processes?
a. Immune function and clearance of intravascular debris
b. Glucose production and lactate clearance
c. Synthesis of plasma proteins
d. Normal metabolic supply and demand
6. Which of the following
Isaac Chinnappan MS CCP
statements is true regarding
LCP FPP CPBMT
hepatic blood flow?
a. Required for synthesis of RBC
b. Required for glucose metabolism
c. No effective autoregulation during CPB
7. Which statement is correct regarding liver function?
a. Hepatic glucose production is stimulated by glucagon
b. Glucagon is a pancreatic hormone
c. The role of glucagon is impaired during CPB
d. All of the above
8. Post pump jaundice is due to __________.
a. Infection
b. Reperfusion injury
c. Excessive transfusion
d. Normothermia
9. Which of the following are common clinical
complications of CPB?
a. GI bleeding
b. Intestinal ischemia
c. Pancreatitis and cholecystitis
d. All of the above
10. Endotoxemia post CPB may be due to __________.
a. Hypoperfusion
b. Hyperthermia
c. Hypertension
Answers to Quiz on page
Page 19
SELF QUIZ
11. Insulin resistance is due to which of the following?
a. Failure to suppress endogenous hepatic glucose production
b. Failure to stimulate peripheral glucose uptake
c. All of the above
12. Type I Diabetes mellitus can be described as a __________.
a. Prediabetic state
b. Failure of cells to use insulin
c. Failure to produce insulin
13. Type II Diabetes mellitus can be described as a __________.
a. Prediabetic state
b. Failure of cells to use insulin
c. Failure to produce insulin
14. Diabetic Ketoacidosis results from which of the following?
a. Shortage of insulin
b. Failure to produce insulin
c. Failure of cells to use insulin
d. Low glucose levels
15. Increasing MAP during CPB with phenylephrine instead of
increasing pump flow compromises splanchnic perfusion.
a. True
b. False
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Perfusion
Review Class
Now Available!
35 hours of new
study material!
150 Category 1 Self
Directed Continuing
Education (SDCE) Hours
Now Available at AmSECT U!
AmSECT U is available for free to all AmSECT
Members. This is just one of the perks of
AmSECT membership.
Have Something to Add?
AmSECT Today invites you to share
your constructive thoughts and feedback.
This is your chance to make AmSECT Today
a more interactive experience.
Send your letters to the Editor, [email protected]
Deadline: February 1, 2016 for the
March/April issue.
Members...
This innovative opportunity is already in place
for you, with easy access at amsectu.org with
your member login.
Not a Member Yet?
You can log in as a guest to view some of the
informative courses. Then visit amsect.org and join
AmSECT for your own personal access to all that
AmSECT University has to offer!
BOB GROOM passes the baton to JULIE WEGNER
AmSECT’s Journal of ExtraCorporeal Technology (JECT) will mark another major milestone in
March. With the board’s recent approval, Robert C. Groom MS CCP FPP is handing the
JECT editorship to Julie Wegner PhD CP. Bob has served as JECT editor-in-chief since 2006,
completing his 10th year in December 2015.
Julie Wegner completed her doctorate in physiology from the University of Arizona in May 1991.
She received her perfusion education at the University of Arizona in August 1992 and mastered her ABCP
exams in 1993. Julie was a staff perfusionist at University Medical Center in Tucson from 1992 to 2002.
After Tucson, she worked as a clinical trainer/educator for Haemoscope, Inc. until 2008 where she helped
to create the educational program for the thromboelastograph technology. Julie taught in the Midwestern
University Perfusion Education program from 2002 until 2012. Currently she provides lectures related to
coagulation and vascular physiology for the University of Nebraska and University of Arizona perfusion
programs. Julie has authored 12 peer reviewed scientific papers and two book chapters in the areas of
cardiac surgery, perfusion and cardiac assist devices. Julie served AmSECT members as the co-chairman
for the New Advances in Blood Management conference planning committee from 2007 to 2013.
In regard to JECT, Julie has been an associate editor since 2000 and has served as an editorial
advisor to Robert Groom since 2013. Julie attended the Council of Science Editors Conference in Montreal in March 2013 and completed the Short Course for Editors. She has strategized with Bob regarding the application and review with
PubMed Central (PMC), reducing the time frame for the review process, recruitment of review papers, the open access initiative with PMC
and the mobile app. Since 2008, Julie has reviewed 42 manuscripts and completed 38 on time or early. Her average review completion time
is 10 days. While serving as a JECT associate editor, Julie has supervised the entire peer review process and decision on ten manuscripts.
Bob Groom replaced Al Stammers as JECT editor-in-chief in 2006 and has successfully continued
the momentum that Al injected into the journal process during his five years as editor. Bob has written 25
letters from the editor for JECT. Bob reports that his last letter, “What does quality mean to perfusionists?”
(JECT 2015;47(4): InPress) is his favorite because it lists all the tools CCPs need to execute quality practice.
Not counting his 25 letters, Bob has published more than seven manuscripts in JECT. To illustrate
his breadth of influence in cardiac surgery and perfusion, he has published another 75 articles in other
journals, not to mention four book chapters. Bob cites the addition of JECT to PubMed Central and the
archiving of JECT articles in the National Library of Medicine for open access as his most important accomplishments as editor.
Bob will be remembered for his professional and timely interactions with authors and the JECT editorial board members. Julie will continue Bob’s work with JECT and will leverage her academic skill set to
be a thorough and thoughtful editor with professional vision.
Jeffrey B. Riley MHPE CCT CCP, AmSECT President
Page 21
JECT Open Access
is now Open Access
through the NIH
PubMed Central Archive!
The Journal of ExtraCorporeal Technology (JECT) has been one of the principal
avenues used by AmSECT in pursuit of its mission (“…providing for the continuing
education and professional needs of the extracorporeal community…”) through the
publication and dissemination of scholarly work since 1967.
Our affiliation with PubMed Central promotes even further dissemination of our
scientific content. PMC is a free archive of biomedical and life sciences journal
literature at the U.S. National Institutes of Health’s National Library of Medicine.
What is available from PMC?
New issues of JECT are embargoed for six
months and then released to PubMed Central.
Currently, all content back to December 2011
is available. Soon the archive will be expanded
to include articles back to March of 2005. Full articles, PDFs and figures my be
downloaded for free.
Exciting news! How do I access it?
Visit
http://www.ncbi.nlm.nih.gov/pmc/journals/2798
to download JECT issues older than six months.
JECT can also be found by conducting a search on PMC.
P E D IATR IC P ER FUS ION
Little
Hearts
Exit to ECMO
By Kellen Goldberg MPS CCP
Staff Perfusionist, Clinical Coordinator Children’s Hospital of Alabama
In neonates born with hypoplastic left heart syndrome or severe
aortic stenosis, most of the blood flow to the body is pumped from the
right ventricle through the patent ductus arteriosus (PDA). Therefore, there
must be an opening or intracardiac lesion that allows the oxygenated
blood from the left side of the heart to mix with the right and be delivered
to the body. If there is no intracardiac mixing, it can lead to a serious and
life threatening condition where the patient is unable to deliver oxygenated blood to the body. Early intervention is needed in these patients to
increase the chance of survival to palliative surgery.
Within the last five years, there have been technological advances
to increase the portability of ECMO. Smaller disposables and portable
ECMO pumps have allowed clinicians to increase the versatility of ECMO.
In addition, the emergence of multidisciplinary ECMO teams has helped
standardize patient care and made the therapy more predictable and reliable. We have started to use Exit to ECMO strategies for early intervention
in children born with these complex cardiac lesions with intact septum.
During the gestation of the child, there are fetal team (OBGYN, cardiologists, surgeons, neonatalogists, perfusionists) meetings where cardiologists
evaluate potential patients that may require early intervention. Early detection of these complex lesions is imperative for achieving the best outcome for
the patient. Once a suspected lesion is confirmed, the multidisciplinary team
meets and discusses the possibility and approach of Exit to ECMO. Here
at Children’s of Alabama, we are fortunate that there has been advanced
planning resulting in proximity of our hospital to the UAB women and infants
center (WIC). The WIC is next door and has a walkway that connects the two
facilities. The two hospitals have worked together to establish credentials
for the clinicians, processes for blood product and drug availability, and
standardized transport monitoring equipment.
Once born in the delivery operating room via cesarean section, the
child is taken to the resuscitation area where the ECMO intervention
team (surgeons, intensivists, perfusionists, anesthesiologists, nurses and
respiratory therapists) is ready. One intensivist puts in umbilical artery and
venous catheters while another intensivist or cardiovascular anesthesiologist intubates the patient. The protocol (see sidebar to the right) is the
checklist the perfusionists use as a reference for preparation. Using the
patient’s arterial saturations, arterial pressure and ventilation adequacy, the
intensivists and surgeon will determine whether the patient needs ECMO.
If ECMO is needed, the procedure will be handed off to the CVOR team.
The surgeon will place ECMO cannulae in the right carotid artery and
jugular vein while the CV intensivists are in charge of drug administration
and ventilation. The ECMO pump is primed with Plasmalyte-A, 25 percent
albumin, sodium bicarbonate, heparin (100 U/kg), calcium chloride and
donor red blood cells. ECMO is initiated and maintained to keep adequate
perfusion. Once ECMO has been established and the patient is stabilized,
Kellen Goldberg MPS CCP
they are transported to the hybrid catheterization lab at Children’s of
Alabama to undergo a balloon atrial septostomy. The patient is expected
to be weaned off ECMO within 48 hours.
The future of portable ECMO and fetal/neonate ECLS is very exciting.
The emergence of smaller machines, carts and disposables has allowed
clinicians to push the current boundaries of ECMO. Before establishing
our Exit to ECMO procedure, there were between three and five neonates
each year who died in the resuscitation room immediately after birth. The
proximity of our fetal and neonatal services has enabled us to provide
better care for these complex cardiac lesion patients.
CV Perfusion
Exit to ECMO Checklist
Supplies Needed Before Patient is Born
• Delivery Hospital emergency release blood (O-) or crossmatched units from mother
• ECMO medications from delivery hospital (Albumin 25 percent,
Heparin 1000 U/mL, Sodium Bicarbonate 1 mEq/mL, Calcium
Chloride 100 mg/mL)
• Pressure monitoring setup with portable monitor for transport
• Two pump circuits: one ECMO outside of delivery room and
one CPB standby outside of hybrid catheterization lab
• ECMO cart with all cannulation supplies and POC devices
• Portable room air and oxygen tanks (with quick connects)
Priming the ECMO Circuit
• The ECMO circuit is primed with Plasmalye-A and drugs
before the child is born
• The donor red blood cells are added once it has determined
ECMO will be required
• Talk with surgeon to determine appropriate cannulae size
Postnatal Patient Parameters
(subject to change based on each patient’s need)
• Guidelines agreed upon at fetal team meeting prior to birth
• SaO2 > 70 – HLHS conventional care at the CVICU
• SaO2 50-70 – Take to cath lab for a balloon atrial septostomy
• SaO2 < 50 – Exit to ECMO and take to cath lab for a balloon
atrial septostomy
Page 23
Foundation Donors as of December 28, 2015
Honors Circle
Donations $2,000 and Above
Lee Bechtel
Colette S. Calame BS CCP FPP
FO
U N D AT I O N
Patron
Tyler Samolyk, Global Blood Resources
Donations up to $249
Missouri Perfusion Society
David L. Anderson CCP
Diane Beall
Michael Brigham
Kelly Clayberg CCP
Holly Colavin RN CCP
Jacqueline Conzemius CCP
Kevin J. Cotter CCP LP
Terry N. Crane BS CCP LP
Bobby J. Curtis
Jay B. Denman, Jr.
Joseph Duffell BS CCP
Robert M. Dyga CCP CPBMT
Mark J. Fanning CCP
Deborah Frankenberg CCP
Patrick J. Frost CCP
Kyra E. Grathwohl CCP
Bonnie L. Hamilton CCP
Joseph P. Hearty III CCP
Eileen L. Heller-Stading CCP
Chris Holland
William J. Horgan CCP Emeritus
Frank B. Hurley BS CCP LP
Zhenxiao Jin MD
Bill Klausing CCP
Thomas M. Klein BS CCP LCP FPP
Brian J. LaLone PhD CCP
Karen Lautzenheiser CCP BS
Deborah Madan CCP
Rob Murrell
Robert J. Picotte CCP Emeritus
Susan C. Ratty-Seeman CCP
Yanine Rivera CCP
David Simpson CCP LP
Brian Smith CCP
Oliver Sommer
Thomas G. Steffens MPS CCP LP FPP
Catherine H. Taylor CCP
Craig R. Vocelka CCP MDiv
Rocky Mountain Perfusionists, Inc.
Leadership Council
Donations $1,000-$1,999
Dawn M. Oles MHPE CCP LP
Benefactor
Donations $500-$999
Bruce Bartel CCP Emeritus
Robert C. Groom MS CCP FPP
Ron Richards CCP CPBMT
Ruggles Service Corporation
Scott Snider CCP
Friend
Donations $250-$499
Nancy L. Achorn BA CCP
Philip C. Crawford CCP
Susan Jones Englert RN CCP CPBMT
Bill J. Fiddler, Jr. CCP
George Justison BS CCP
Robert D. Longenecker BS CCT LCP CCP
Virginia W. Longnecker MEd CCP Emeritus
Kirti P. Patel MPS MPH CCP LP CPBMT
Calvin R. Scott
Ian R. Shearer BS CCP
have at our institution.
In this pack, we have a Maquet Quadrox-IR oxygenator (hollow
fiber), Maquet VHK 2000/2001 Venous Hardshell Cardiotomy Reservoir
and other essentials to make a full heart lung machine “to go.” We offer
VAVD, level alarms, arterial flow detection with air bubble detection,
venous bubble detection, manifold, as well as an arterial pressure transducer. All of this equipment fits on the Sprinter Cart XL from Maquet
(in Figure 7, sprinter cart has off label side shelf for cardioplegia option).
We use the Maquet Quadrox-IR pack for certain cases because the
centrifugal pump is integrated into the oxygenator and has an integrated
Bypass “To Go” –
A Multipurpose Circuit
By Shahna L. Bronson CCP
International Consortium for EvidenceBased Perfusion (ICEBP)
Happy New Year! As we begin
2016, there are a lot of routines that we
go through. Many of us set goals, make
challenges and decide that things are
going to be different this time around.
It’s a great way to ensure success and
even give ourselves a plan of action for
success.
Shahna L. Bronson CCP
This month, I’d like to talk about
something that is not routine: perfusion. As perfusionists, we are never
faced with the same routine. Sure, we talk big about having a routine –
having the same pattern for our pump setup, pump runs, etc. so that we
prevent mistakes. But, in general, when really discussing the bypass run,
each and every case is different. A pump run is not routine and neither
are the expectations from our surgeons or institutions. I have found as
the years go on there is always something “new” the surgeons want to
do or a new practice they want to incorporate, which means more “fun”
for perfusion.
Our job is to come up with the necessary tools and techniques that
allow them to perform these “latest and greatest” practices. This is exactly
what Kevin Devnich, Mercy Medical Center’s perfusion manager/ECMO
coordinator has done. This institution does about 1,000 cases per year,
including open hearts, pediatrics, LVAD (Heartmate 3), ECMO, lead
extractions and TAVR. I want to share with you their recent experience
as an example.
Mercy was faced with a challenge: how to offer full cardiopulmonary
support without a full heart-lung machine. A complete onset of perfusion
creativity strikes again! Devnich needed a circuit, capable of full bypass,
for TAVR cases and lead extractions performed in a hybrid room built in
2008. In addition, this circuit needed to be small and transportable. We
have our hybrid OR and cath lab in different parts of the hospital. We
do TAVRS in both depending on the availability of the room.
Because of his experience working in this institution, he did not
seek to create extra packs or order more expensive equipment. I assume that for many of you, just like us, it doesn’t benefit your institution
to have several packs on the shelf or maintain equipment with very
specific needs. Usually caseload doesn’t justify such specificity, leading
to expiration, wasted time and money. Therefore the approach became,
“let’s use what we’ve got.” Devnich helped design a pack with Maquet,
referred to as the Maquet IR pack, for use with the Cardiohelp we already
Figure 1
Figure 2
Figure 3
Figure 4 - With reservoir
Figure 5 - Without reservoir
Figure 6
Page 25
Figure 7
arterial filter as well. This IR oxygenator is also less expensive than the
red diffusion oxygenator from the standard Maquet HLS set. It is less
expensive because the IR oxygenator is a hollow fiber oxygenator and
does not have integrated pressure and temperature sensors.
The way that this circuit was designed, there are two options available with a simple movement of large Roberts clamps.
If necessary, we house a Sarns 8000 roller pump under the Cardiohelp for an extra sucker. We also have a Sarns 8000 roller pump on the
tray to the right of the Cardiohelp for the Sorin 1:4 coil heat exchanger
that cools cardioplegia in a bucket. So, with this circuit and IR pack, you can support whatever situation
arises. If the surgeon needs temporary support for getting a fibrillating
rhythm under control, you can go on bypass and provide temporary
extended life support until the situation is under control. Another option,
if they have a hemodynamic issue, need PCI support or require decompression of an aneurysm repair, is to open the reservoir and provide full
cardiopulmonary bypass with cardioplegia.
Your final option is ECMO. Once on ECMO, you would clamp out
reservoir and use the IR oxygenator until it needs to be changed out
(recommendations are <3 hours) then replace with the Maquet HLS set
that includes the ECMO diffusion oxygenator used every day (the IFU
reads ≤6 hours long term support). Using your backup Cardiohelp, you
can prime the HLS set and then perform a routine oxygenator changeout.
I hope that sharing our experience and circuit will help you in your
own practice. We have had great success with the circuit and everyone
appreciates the small footprint. This is an excellent example of another
perfusion team fulfilling a surgical need without increasing expense or
requiring exclusive supplies. This pack was created for Mercy Medical
Center, and, at this point in time, we are the only institution in the United
States using it. However, as many institutions around the nation attempt
to fulfill the “hub and spoke” commitments with other larger institutions,
making the Cardiohelp as useful as possible becomes essential.
Once the Cardiohelp is purchased, your institution will want to
maximize its usefulness. Maquet is working to help perfusionists use
the Cardiohelp as a platform device, meaning that the Cardiohelp will
be the main machine but with several different options available. They
are working to make the Cardiohelp useful for more than just ECMO.
Hospitals are using Cardiohelp for ECPR, cardiogenic shock, cooling
patients down, rewarming hypothermic patients, TAVRs, lead extractions
and descending aneurysms. Future disposables are being developed for
pediatrics, CO2 removal and circulatory support. The Maquet Cardiohelp
is on it’s way to becoming a versatile 22-lb heart lung machine!
Figure 8
Figure 9
R EGIS TER NOW !
P L A N NOW TO ATTEND!
Page 27
President’s Message
What I learn from my coworkers and students I relish, although occasionally the learning is very tough on my ego. I have listed my coworkers
from Mayo Clinic at the end of my message. I am thankful for and appreciate their direct and indirect support while I have had the opportunity to
serve AmSECT. I am thankful for my operations managers Renee Jones
and Ron Alston and our CV Surgery division chair, Dr. Joseph Dearani for
their support of AmSECT. Many of my decisions as an AmSECT leader
have been shaped by their input. I stand on their shoulders every day.
Other groups for which I am thankful to have in my professional life
include the AmSECT board of directors, the executive committee and the
many committee and task force members who serve our membership.
The same principles hold true. In AmSECT, I am surrounded by intelligent
perfusionists where my No. 1 job is to listen. AmSECT’s volunteers are all
bright lights in my professional life. They help bring our profession to life
for our membership through the many initiatives and accomplishments
their efforts support.
AmSECT’s transition task force, led by Kenny Shann, successfully
and capably completed their work on Dec. 22, 2015. I am thankful that the
transition to our new management group went well. The success is largely
due to the transition team at SmithBucklin, led by Janet Rapp and Erin
Butler, and to the most gracious Donna Pendarvis on the sending end. I
am thankful for the management partners we had for the last 10 years. I
am thankful for AmSECT’s newly expanded resources.
We are ever thankful for the AmSECT leader perfusionists who we
lost in the last 18 months: Jeri Dobbs, Alan Lumus, Maddie Massengale
and Calvin Scott. These perfusionists, like so many other pioneers,
shaped our professional lives, our society and kept AmSECT on track
over the decades. We stand today and every day on their shoulders and
accomplishments.
It may be a cliché but never has a cliché been truer: any success
I have had as a leader is due mainly to the people around me and the
mentors who have guided me. I stand on the shoulders of many people.
You, too, stand on the shoulders of many.
Mayo Clinic Hospital Perfusion Team
Rochester, Minnesota
Angeleah Ramirez
Autumn Gibbs
Bill Levenick
Caitlin Blau
Dan Erpelding
Dan Hostetler
David Cardwell
Dawn Oles
Erica Beach
James Neal
Jeff Amendola
Josh Blessing
Kathryn Levenick
Marvin Gohman
Mathew Schuldes
Phil Scott
Shu Li
Timothy Dickinson
Zhen Ren
Amanda Cornelius
SELF-QUIZ ANSWERS
1. d
4. b
7. d
10.a
13.b
2. c
5. a
8. c
11.c
14.a
3. d
6. c
9. d
12.c
15.a
Self Quiz can be found on page 18.
T HANKS T O O UR
CO RPO RAT E SPO NSOR S
GOLD LEVEL
LivaNova (formerly Sorin Group, Inc.)
MAQUET Medical Systems, Inc.
Medtronic
Spectrum Medical
Terumo Cardiovascular
Group
SILVER LEVEL
Thoratec Corporation
BRONZE LEVEL
HAEMONETICS®
Quest Medical, Inc.
CORPORATE SPONSOR
Cincinnati Sub-Zero Products
Grifols
SpecialtyCare, Inc.
Award of Excellence
AmSECT Website Sponsor
Sponsor
Thoratec Corporation
NFO Healthcare
AmSECT App Sponsor
Industry Insurance
Medtronic
Services, Inc.
Breakfast Sponsor
Perfusionist of the Year
Spectrum Medical
Sponsor
Dinner Symposium
Medtronic
Sponsor
Scholarship
MAQUET
Contributors
Speakers Reception
NFO Healthcare
Sponsor
Industry
Insurance
MAQUET
Services,
Inc.
Charging Station Sponsor
Terumo Cardiovascular
MAQUET
Group
Water Station Sponsor
MAQUET
EXHIBITORS
CAPS/B. Braun
(Central Admixture
Pharmacy Services, Inc.)
CardiacAssist, Inc.
CASMED
Global Blood Resources
Helena Laboratories
MicroAire Surgical
Instruments, LLC
NFP Healthcare
Industry Insurance
Services, Inc.
rEVO Biologics
Page 29
DETERMINED
TIRELESS
PERSISTENT
STEADFAST
ENDURING
Cardiovascular disease is relentless. So is your
commitment to the highest level of patient care.
That’s why at Terumo Cardiovascular Group, we are relentless in our mission to provide
and advance lifesaving technologies for cardiac surgery teams around the world.
Upholding our commitment to the perfusion community, we are pleased to announce that the general
Quality System for our Ann Arbor, Michigan site is in compliance with U.S. FDA regulations and that
shipping restrictions have been lifted for the CDI ® Blood Parameter Monitoring System 500 hardware.
Global demand for the CDI System 500 technology is strong, and we are ramping up production to begin
shipping product later this year. We understand just how important continuous monitoring is to improving
blood gas management and patient outcomes.1, 2
Terumo. The people, the products and the programs to support your relentless passion for patient care.
Learn about Terumo’s efforts to support lifesaving work at terumo-cvgroup.com/relentless
1
2
Ottens J, et al. Improving Cardiopulmonary Bypass: Does Continuous Blood Gas Monitoring Have a Role to Play? Journal of Extra-Corporeal Technology, 2010; 42:191-198.
Trowbridge C, Stammers A, et al. The Effects of Continuous Blood Gas Monitoring During Cardiopulmonary Bypass: A Prospective, Randomized Study, Part II. Journal of Extra-Corporeal Technology, 2000; 32: 129-137.
Terumo Cardiovascular Group Ann Arbor, Michigan USA 734.663.4145 800.521.2818
Terumo® is a registered trademark of Terumo Corporation. CDI® is a registered trademark of Terumo Cardiovascular Systems Corporation.
©2015 Terumo Cardiovascular Systems Corporation. May 2015. 861271

Bylaws Committee

Transcription

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