Perfusion education programs use simulation to provide students with clinical skills prior to ent... more Perfusion education programs use simulation to provide students with clinical skills prior to entering the operating room. To teach the psychomotor execution of skills in a simulation lab requires a list of validated skills and deconstructed sub-steps to fully optimize adult learning. A list of the fundamental skills of adult cardiopulmonary bypass (CPB) was recently published; however, no defined list exists regarding pediatric CPB skills. The purpose of this survey is to form a definitive list of skills fundamental to pediatric CPB. A survey of 23 proposed pediatric CPB clinical skills and 291 proposed skill sub-steps was developed. Proposed pediatric CPB skills were evaluated using an established frequency and harm index. If the skill is performed >50% of the time (frequency), and if >50% believe that if the skill is performed incorrectly patient harm is probable (risk), then the skill is accepted as fundamental. The survey content was validated by subject matter experts and then distributed to practicing perfusionists between September 2020 and December 2020. Of the 125 survey respondents, 57.9% had 10 or more years in the field. 35.2% of respondents are American Society of Extracorporeal Technology (AmSECT) Fellows of Pediatric Perfusion (FPP) and pediatric CPB represents >50% of the annual caseload for 69.7% of respondents. 22 of the 23 proposed skills were accepted as fundamental in the conduct of pediatric CPB and 258 of the 291 proposed sub-steps associated with CPB skills were accepted as integral to skill performance. By surveying practicing pediatric perfusionists, this study identifies 22 skills as fundamental to the safe execution of pediatric CPB. In addition, skill sub-elements were identified as necessary for skill execution. This knowledge will assist perfusion programs in developing a pediatric simulation curriculum that matches current clinical execution of pediatric skills.
The number of patients awaiting kidney transplantation has more than doubled in the past decade w... more The number of patients awaiting kidney transplantation has more than doubled in the past decade while the number of available donor organs has seen only a modest increase, leading to a critical shortage of organs. In response to this extreme shortage, the criteria for accepting organs have been modified to include marginal donors such as non-heart beating donors (NHBD). In these kidneys, determining viability is important for success of transplantation. Therefore, a study was undertaken to develop a system that would allow the extra-corporeal assessment of function and compatibility of the donor organ before the patient is exposed to the risks associated with surgery. Following bilateral nephrectomy, the kidneys of 10 pigs (~30 kg) were connected to a commercially available hypothermic pulsatile kidney perfusion apparatus. This system was modified to allow for normothermic pulsatile renal perfusion using the potential recipient’s blood, via vascular access. These kidneys were perfused with the animal’s blood for a minimum of two hours while various parameters were monitored. Perfusion pressures were kept between 60 and 90 mmHg, which correlated to flows between 70 and 150 mL/min. A decrease in perfusion pressure with a concomitant rise in flow over the two-hour period served as a good predictor of a viable and compatible graft. The modified kidney preservation system allows the normothermic, pulsatile extracorporeal perfusion of donor kidneys with the ability to monitor resistance to flow and urine production. This model also allows observation of the kidney for signs of hyperacute rejection. Further research needs to be conducted in order to determine if the system represents a methodology to increase the pool of available donor organs.
Cell phone use in the U.S. has increased dramatically over the past decade and text messaging amo... more Cell phone use in the U.S. has increased dramatically over the past decade and text messaging among adults is now mainstream. In professions such as perfusion, where clinical vigilance is essential to patient care, the potential distraction of cell phones may be especially problematic. However, the extent of this as an issue is currently unknown. Therefore, the purpose of this study was to (1) determine the frequency of cell phone use in the perfusion community, and (2) to identify concerns and opinions among perfusionists regarding cell phone use. In October 2010, a link to a 19-question survey (surveymonkey.com) was posted on the AmSECT (PerfList) and Perfusion.com (PerfMail) forums. There were 439 respondents. Demographic distribution is as follows; Chief Perfusionist (30.5%), Staff Perfusionist (62.0%), and Other (7.5%), with age ranges of 20-30 years (14.2%), 30-40 years (26.5%), 40-50 years (26.7%), 50-60 years (26.7%), >60 years (5.9%). The use of a cell phone during the performance of cardiopulmonary bypass (CPB) was reported by 55.6% of perfusionists. Sending text messages while performing CPB was acknowledged by 49.2%, with clear generational differences detected when cross-referenced with age groups. For smart phone features, perfusionists report having accessed e-mail (21%), used the internet (15.1%), or have checked/posted on social networking sites (3.1%) while performing CPB. Safety concerns were expressed by 78.3% who believe that cell phones can introduce a potentially significant safety risk to patients. Speaking on a cell phone and text messaging during CPB are regarded as "always an unsafe practice" by 42.3% and 51.7% of respondents, respectively. Personal distraction by cell phone use that negatively affected performance was admitted by 7.3%, whereas witnessing another perfusionist distracted with phone/text while on CPB was acknowledged by 33.7% of respondents. This survey suggests that the majority of perfusionists believe cell phones raise significant safety issues while operating the heart-lung machine. However, the majority also have used a cell phone while performing this activity. There are clear generational differences in opinions on the role and/or appropriateness of cell phones during bypass. There is a need to further study this issue and, perhaps, to establish consensus on the use of various communication modes within the perfusion community.
The ideal location of air bubble detector (ABD) placement on the cardiopulmonary bypass (CPB) cir... more The ideal location of air bubble detector (ABD) placement on the cardiopulmonary bypass (CPB) circuit is debatable. There is, however, very little data characterizing the prevalence of specific ABD placement preferences by perfusionists. Therefore, the purpose of this study was to survey the perfusion community to collect data describing the primary locations of air bubble detector placement on the CPB circuit. In June 2011, an 18-question on-line survey was conducted. Completed surveys were received from 627 participants. Of these, analysis of the responses from the 559 certified clinical perfusionists (CCP) was performed. The routine use of ABD during CPB was reported by 96.8% of CCPs. Of this group, specific placement of the bubble detector is as follows: distal to the venous reservoir outlet (35.6%), between the arterial pump and oxygenator (3.8%), between the oxygenator and arterial line filter (35.1%), distal to the arterial line filter (ALF) (23.6%), and other (1.8%). Those placing the ABD distal to the venous reservoir predominately argued that an emptied venous reservoir was the most likely place to introduce air into the circuit. Those who placed the ABD between the oxygenator and the arterial line filter commonly reasoned that this placement protects against air exiting the membrane. Those placing the ABD distal to the ALF (23.6%) cited that this location protects from all possible entry points of air. A recent false alarm event from an ABD during a case was reported by 36.1% of CCPs. This study demonstrates that the majority of CCPs use an ABD during the conduct of CPB. The placement of the ABD on the circuit, however, is highly variable across the perfusion community. A strong rationale for the various ABD placements suggests that the adoption of multiple ABD may offer the greatest comprehensive protection against air emboli.
Serious complications during the performance of cardiopulmonary bypass (CPB) are an infrequent ev... more Serious complications during the performance of cardiopulmonary bypass (CPB) are an infrequent event. However, when potentially fatal technical complications, such as oxygenator or pump failure, do occur, it necessitates a swift and well-coordinated response. Periodic performances of drills that simulate various CPB crises are a way to improve individual perfusionist proficiency during disaster situations. The purpose of this study is to determine the utilization of crisis management drills in perfusion departments. Every open-heart program listed by the American Hospital Association in the New England states (Maine,
The dramatic increase in the use of extracorporeal membrane oxygenation (ECMO) over the last deca... more The dramatic increase in the use of extracorporeal membrane oxygenation (ECMO) over the last decade with the concomitant need for ECMO competent perfusionists has raised questions of how well perfusion education programs are preparing entry-level perfusionists to participate in ECMO. While all perfusion schools teach ECMO principles, there is no standardized or systematic approach to the delivery of didactic knowledge and clinical skills in ECMO. Given this variability of ECMO education across and within perfusion schools, the CES-A exam may provide a metric for comparing curricular approaches. The purpose of this study is to examine three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We examined three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We hypothesized that there would be no difference in CES-A pass rate, exam score, Rasch measure, and item category scores between SUNY Cardiovascular Perfusion Program (CVP) graduates who completed SUNY's ECMO Capstone experience (Group III) and CVP graduates who did not select the ECMO Capstone experience (Group II). Further, we studied the performance of a third group of new graduates from an external program that does not offer formal ECMO courses or an ECMO Capstone experience (Group I). Every perfusion graduate in all groups passed the adult ECMO specialist exam. The graduates who as students completed an ECMO Capstone experience (Group III) scored higher on the exam and significantly higher on four exam categories: coagulation and hemostasis (p = .058), lab analysis point of care (p = .035), and monitor patient and circuit (p = .073), and the safety and failure modes (p = .017). Overall the median graduate Rasch measures ranked with Group III demonstrating the highest measure to Group I the lowest measures (not significant at p = .085). There is a positive educational effect due to CVP graduates completion of the ECMO Capstone experience compared to the program standard ECMO-related curricula in the two perfusion programs participating in this study. From this observation a structured ECMO simulation-based program appears to be equally effective as a traditional, typical lecture-only, clinical perfusion preceptorship, while demonstrating a more satisfactory experience with a higher reported case experience. In this study the standard perfusionist education curriculum prepared the new graduate to be successful on the CES-A exam. The three curricular approaches appear to prepare perfusionist graduates to be successful on the Adult ECMO Specialist exam.
The journal of extra-corporeal technology, Dec 1, 2014
Pressure data acquired from multiple sites of extracorporeal circuits can be an important paramet... more Pressure data acquired from multiple sites of extracorporeal circuits can be an important parameter to monitor for the safe conduct of cardiopulmonary bypass (CPB). Although previous surveys demonstrate that CPB circuit pressure monitoring is widely used, there are very little data cataloging specific applications of this practice. Therefore, the purpose of this study is to survey the perfusion community to catalog 1) primary CPB circuit site pressure monitoring locations; 2) type of manometers used; 3) pressure monitoring interface and servoregulation with pump console; and 4) the rationale and documentation associated with pressure monitoring during CPB. In June 2013, a validated 27-question online survey was sent directly through an e-mail link to the chief perfusionists in the northeast United States. Completed surveys were received from 75 of 117 surveys deployed yielding a 64% response rate. Arterial line pressure monitoring during CPB is reported by 99% with six distinct circuit site locations identified. Cardioplegia system pressure was monitored by 95% of the centers. For vacuum-assisted venous drainage (VAVD) users, the venous pressure was measured by 72% of the responding centers. Arterial line pressure servoregulation of the arterial pump was indicated by 61% of respondents and 75% of centers record arterial line pressure in their perfusion record. Most centers (77%) report the use of a transducer that is integrated into the pump console providing a digital pressure display, whereas 20% combine an aneroid gauge manometer with the integrated digital transducer. This study demonstrates that the practice of arterial line pressure monitoring during CPB is nearly universal. However, the selection of the pressure monitoring site on the circuit, modes of monitoring pressure, and their applications are highly variable across the perfusion community.
Despite the widespread use of vacuum-assisted venous drainage (VAVD) and case reports describing ... more Despite the widespread use of vacuum-assisted venous drainage (VAVD) and case reports describing catastrophic incidents related to VAVD, there is a lack of data cataloging specific safety measures that individuals and institutions have incorporated into their VAVD practices for the prevention of these incidents. Therefore, the purpose of this study is to survey the perfusion community to gather data on VAVD practices, and to compare these current practices with literature recommendations and the American Society of ExtraCorporeal Technology (AmSECT) Standards and Guidelines. In September 2014, a survey was distributed via PerfList and PerfMail, and by direct e-mail to members of the New York State Society of Perfusionists, targeting certified clinical perfusionists in New York State. Survey topics pertaining to VAVD practice included 1) equipment, 2) pressure monitoring and alarms, 3) protocols, checklists, and documentation, and 4) VAVD-related incidents. Of ∼200 certified clinical perfusionists who live and/or work in New York State (NYS), 88 responded (42%). Most respondents (90.1%) report they use VAVD. Of these, 87.3% report that they monitor VAVD pressure, with 51.6% having audible and visual alarms for both positive and excessive negative pressures. At the institutional level, 61.2% of respondents reported that there is a protocol in place at for their team limiting negative pressure in the reservoir, 28.4% document VAVD pressure in the pump record, and AmSECT's three recommended VAVD checklist items are met with 53.7%, 55.1%, and 33.8% compliance. In conclusion, the results of this study reveal that the use of VAVD has increased and has become nearly universal in 2014. There is high compliance to some of the literature recommendations and AmSECT Standards and Guidelines, however, there are still some gaps between current practices and these recommendations. Continued improvement, both at the individual and institutional levels, will help to improve patient safety by preventing untoward events from occurring while using VAVD.
Monitoring activated clotting time (ACT) during extracorporeal procedures is virtually universal.... more Monitoring activated clotting time (ACT) during extracorporeal procedures is virtually universal. The ACT test is usually performed immediately following blood collection. However, certain situations may occur that delay rapid measurement. It is unknown how an aged blood sample affects the ACT measurement. It is hypothesized that the ACT will be affected as a blood sample ages. Multiple blood samples were taken from six patients undergoing cardiopulmonary bypass (CPB). Samples were divided into two groups, heparinized (H) and unheparinized (UH). ACT/HMT tests were performed with each sample on eight devices (Array Actalyke, Gem PCL, Hemochron Jr. Signature, Hemochron Response, Hemochron 801, Hemotec HMS, Rapidpoint Coag, and Sonoclot II) at three different sample ages [< 60 s (fresh blood), 10 min, and 15 min after sample collection. ACT/HMT results of aged samples (10 min and 15 min after sample collection] were compared to ACT/HMT results for fresh blood using a repeated measures analyses of variance (ANOVA) with Student's-Newman-Keuls post hoc test. In the unheparinized group, no device produced an ACT significantly different from the fresh sample counterpart at the 10 min time point. At the 15 min time point, the Hemochron 801 produced a significantly lower average ACT when compared to the fresh sample. (120 +/- 25 vs. 135 +/- 5 s). In the heparinized group, the Actalyke device produced results with 10 and 15 min aged blood that were significantly longer than fresh blood sample results (ACT < 60 s = 426 +/- 66, 10 min = 457 +/- 82, 15 min = 450 +/- 68 s, p < .05). No other device produced significant differences for either time period. Based on this limited sample population, it seems that accurate ACT may be performed on blood samples up to 15 min old in many devices.
Introduction-Recirculation (R), the shunting of arterial blood back into to the venous lumen comm... more Introduction-Recirculation (R), the shunting of arterial blood back into to the venous lumen commonly occurs during veno-venous extracorporeal membrane oxygenation (VV-ECMO) and renders the monitoring of the venous line oxygen saturation no longer reflective of patient mixed venous oxygen saturation (S V O 2). Previously, we failed to prove the hypothesis that once R is known it is possible to calculate the S V O 2 of a patient on VV-ECMO. We hypothesize we can calculate S V O 2 while using VV-ECMO if we account for and add an additional correction factor to our model for dissolved oxygen content. Therefore, the purpose of this study is to derive a more accurate model that will allow clinicians to determine S V O 2 during VV-ECMO when ultrasound dilution is being used to quantify R. Methods-Using an extracorporeal circuit primed with fresh porcine blood, two stocks of blood were produced; (1) arterial blood (AB), and (2) venous blood (VB). To mimic recirculation, the AB and VB were mixed together in precise ratios using syringes and a stopcock manifold. Six paired stock AB/VB sets were prepared. Two sets were mixed at 20% R increments and 4 sets were mixed at 10% R increments. The partial pressure of oxygen (PO 2) and oxygen (O 2) saturation of the stock blood and resultant mixed blood was determined. The original model was modified by modeling the residual errors with linear regression. Results-When using the original model, as the partial pressure of arterial oxygen (P a O 2) of the stock AB increased the calculated S V O 2 was higher than actual, especially at higher R levels. An iteration of the original model incorporating the P a O 2 level (low, medium, high) and R was derived to fit the data. Conclusions-The original model using R and circuit saturations for the calculation of S V O 2 in VV ECMO patients is an oversimplification that fails to consider the influence of the high PO 2 of arterial blood during therapy. In the future, further improvements in this model will allow clinicians to accurately calculate S V O 2 in conjunction with recirculation measurements.
Pflügers Archiv: European Journal of Physiology, May 1, 1991
The Ca 2 +-gated Ca 2 § release channel of aortic sarcoplasmic reticulum (SR) was partially purif... more The Ca 2 +-gated Ca 2 § release channel of aortic sarcoplasmic reticulum (SR) was partially purified and reconstituted into planar lipid bilayers. Canine and porcine aorta microsomal protein fractions were solubilized in the detergent 3-[(3-cholamidopropyl)dimethylammonio]-l-propane sulphonate (CHAPS) in the presence and absence of 3[H]-ryanodine and centrifuged through linear sucrose gradients. A single a[H]-ryanodine receptor peak with an apparent sedimentation coefficient of 30 s was obtained. Upon reconstitution into planar lipid bilayers, the unlabelled 30 s protein fraction induced the formation of a Ca 2 § and monovalent-ion-conducting channel (ll0pS in 100mM Ca 2 § 360pS in 250 mM K+). The channel was activated by micromolar Ca 2 § modulated by millimolar adenosine triphosphate, Mg 2+ and the Ca2+-releasing drug caffeine, and inhibited by micromolar ruthenium red. Micro-to millimolar concentrations of the plant alkaloid ryanodine induced a permanently closed state of the channel. Our results suggest that smooth muscle SR contains a Ca 2 4_ gated Ca 2 § release pathway, with properties similar to those observed for the skeletal and cardiac ryanodine receptor/Ca 2+ release channel complexes.
Introduction. Some degree of recirculation occurs during venovenous extracorporeal membrane oxyge... more Introduction. Some degree of recirculation occurs during venovenous extracorporeal membrane oxygenation (VV ECMO) which, (1) reduces oxygen (O2) delivery, and (2) renders venous line oxygen saturation monitoring unreliable as an index of perfusion adequacy. Ultrasound dilution allows clinicians to rapidly monitor and quantify the percent of recirculation that is occurring during VV ECMO. The purpose of this paper is to test whether accurate patient mixed venous oxygen saturation (SVO2) can be calculated once recirculation is determined. It is hypothesized that it is possible to derive patient mixed venous saturations by integrating recirculation data with the ECMO circuit arterial and venous line oxygen saturation data. Methods. A test system containing sheep blood adjusted to three venous saturations (low-30%, med-60%, high-80%) was interfaced via a mixing chamber with a standard VV ECMO circuit. Recirculation, arterial line and venous line oxygen saturations were measured and entered into a derived equation to calculate the mixed venous saturation. The resulting value was compared to the actual mixed venous saturation. Results. Recirculation was held constant at 30.5 ± 2.0% for all tests. A linear regression comparison of “actual” versus “calculated” mixed venous saturations produced a correlation coefficient of R2 = 0.88. Direct comparison of actual versus calculated saturations for all three test groups respectively are as follows; Low: 31.8 ± 3.95% vs. 37.0 ± 6.7% (NS), Med: 61.7 ± 1.5% vs. 72.3 ± 1.8% (p &lt; 0.05), High: 84.4 ± 0.9% vs. 91.2 ± 1.1% (p &lt; 0.05). Discussion. There was a strong correlation between actual and calculated mixed venous saturations; however, significant differences between actual and calculated values where observed at the Med and High groups. While this data suggests that using quantified recirculation data to calculate SVO2 is promising, it appears that a straightforward derivative of the oxygen saturation-based equation may not be sufficient to produce clinically accurate calculations of actual mixed venous saturations. Perfusion (2007) 22, 239—244.
Departmental use of perfusion crisis management drills: 2002 survey results. Perfusion 2003;18:29... more Departmental use of perfusion crisis management drills: 2002 survey results. Perfusion 2003;18:299-303.] was a real eye-opener about how much we actually practice what we believe in these practice drills. There is a great deal of excellent information in what you have just shared here. We talk about an incidence rate of oxygenator failure as one in 4,500 patients and, in the back of our minds, we may think that is not a very high incidence. I will tell you, having had a failure accident in my center about ten years ago, when that one in 4,500 incident occurs, it really gets your attention. Shortly after that experience is when we started doing practice drills on a regular basis. You point out many benefits to them. The one thing you emphasized, which was really good, is the declaration of a problem. We practice what you have suggested and, when you start to see a failure, you will save precious time by declaring early. In the failure we had, we had a huge delay in the declaration of the problem. It was over ten minutes and we had difficulty communicating the problem. The normal reaction is that you are in denial, so I think it is very helpful to declare the problem immediately, once it is recognized. The other benefit I would point out from our experience in doing these drills is, if you have a written protocol when you do these drills, it is an excellent opportunity to refine that protocol and to find steps that you can take out so that the tasks can be accomplished more expeditiously. I think this approach makes a difference in the outcome for patients when there is an oxygenator failure. MR. STEVEN RASKIN (Houston, Texas): You bring up some of the things we may overlook as we stay in practice for a while. One of the things you mentioned is Perfusion 25(3) 144-145
Since recirculation during venovenous extracorporeal membrane oxygenation (VV ECMO) reduces oxyge... more Since recirculation during venovenous extracorporeal membrane oxygenation (VV ECMO) reduces oxygen delivery to the patient, monitoring recirculation is necessary to guide clinicians in interventions that may reduce recirculation and thereby optimize patient care. The use of dilutional ultrasound may be a clinically practical way to quantify recirculation during VV ECMO. This study evaluates in a swine model of VV ECMO a dilutional ultrasound techniques ability to provide accurate recirculation data under changing conditions. One 16-kg swine was cannulated with a dual-lumen cannula and placed on VV ECMO. Recirculation measured by using blood oxygen saturations (r = S(preox) - SVO2/S(postox) - SVO2) was compared with recirculation measured by a saline dilution ultrasound technique. Dilutional ultrasound was then used to measure changes in baseline recirculation in the face of (a) cannula repositioning and (b) a drug-induced cardiac output change. The comparison of recirculation calculations between the saturation method and dilutional ultrasound were similar at all flow rates measured. The time for results was much faster with the use of dilutional ultrasound. Induction of recirculation changes by repositioning the cannula or changing cardiac output was rapidly detected using dilutional ultrasound and showed significant differences from baseline recirculation. Dilutional ultrasound provides a clinically practical method to quantify and monitor recirculation in VV ECMO applications and may aid in assessing interventions to improve oxygen delivery.
Introduction: Training students to become entry-level perfusionists requires evaluation and asses... more Introduction: Training students to become entry-level perfusionists requires evaluation and assessment of their clinical skills. While our professional organizations have compiled resources which identify the profession's knowledge base and categorical skills applied to clinical practice, these resources are lacking the necessary detail to develop validated clinical assessment rubrics. Therefore, the purpose of this project is to identify, through expert opinion, the detailed fundamental skills necessary to perform adult cardiopulmonary bypass (CPB). Methods: We define a fundamental skill based upon frequency of use and risk of harm. A skill that experts report is conducted in >50% of their CPB cases-and, if not properly conducted, can cause harm, is deemed a fundamental skill. To identify these skills, a 73-question survey was developed and posted on PerfList and PerfMail from May 2017 to July 2017. Results: The results from 261 respondents were analyzed. The demographics of the participants were representative of the workforce. Twenty skills were surveyed and all 20 met the criteria to be identified as a fundamental skill. Data regarding the actions, assessments and behaviors that may be associated with fundamental skills were also identified. Conclusions: Based upon this survey data, we have identified that there is consensus within our profession regarding the fundamental skills of adult CPB and a core body of actions, assessments and behaviors that experts perform when conducting these skills. This information may be incorporated into the entry-level educational process to inform curricula and design valid assessment rubrics.
A survey by our department revealed that most of the institutions in New England and New York hav... more A survey by our department revealed that most of the institutions in New England and New York have written protocols for low-volume, high-risk, emergency events but few of these centers formally practice these protocols through simulation. We hypothesized that hands-on experience with medical emergency protocols will significantly improve clinician performance. Two groups (n = 24 each) of third semester perfusion students with comparable clinical skills were enrolled in this study. The first group was surprised with an emergent oxygenator change-out drill during a simulation exercise, with no prior warning and without the benefit of a written protocol. The second group was asked to develop a written protocol before they were challenged with the change-out drill. Subsequently, both groups were given a week to practice a protocol for emergent change-out before re-testing. The times for all change-out drills were recorded and the groups were compared with a Student&amp;amp;amp;amp;amp;amp;#39;s t-test. A p-value &amp;amp;amp;amp;amp;amp;lt; 0.05 was considered significant. The group without a written protocol (NP) had the longer time (559.7 +/- 84.9 sec) while the group with the written protocol (P) performed better (461.8 +/- 57.5 sec, p &amp;amp;amp;amp;amp;amp;lt; 0.05). However, both groups achieved significantly better performance following repeated practice (NP = 167.8 +/- 34.8; P = 170.9+/-32.5 sec, p &amp;amp;amp;amp;amp;amp;lt; 0 .05). While written protocols for emergent events will improve patient care, simulation and practice of emergency protocols is the most significant way to protect our patients. Based on this, we advocate for all perfusion groups to simulate emergency events and practice their crisis protocols.
Perfusion education programs use simulation to provide students with clinical skills prior to ent... more Perfusion education programs use simulation to provide students with clinical skills prior to entering the operating room. To teach the psychomotor execution of skills in a simulation lab requires a list of validated skills and deconstructed sub-steps to fully optimize adult learning. A list of the fundamental skills of adult cardiopulmonary bypass (CPB) was recently published; however, no defined list exists regarding pediatric CPB skills. The purpose of this survey is to form a definitive list of skills fundamental to pediatric CPB. A survey of 23 proposed pediatric CPB clinical skills and 291 proposed skill sub-steps was developed. Proposed pediatric CPB skills were evaluated using an established frequency and harm index. If the skill is performed >50% of the time (frequency), and if >50% believe that if the skill is performed incorrectly patient harm is probable (risk), then the skill is accepted as fundamental. The survey content was validated by subject matter experts and then distributed to practicing perfusionists between September 2020 and December 2020. Of the 125 survey respondents, 57.9% had 10 or more years in the field. 35.2% of respondents are American Society of Extracorporeal Technology (AmSECT) Fellows of Pediatric Perfusion (FPP) and pediatric CPB represents >50% of the annual caseload for 69.7% of respondents. 22 of the 23 proposed skills were accepted as fundamental in the conduct of pediatric CPB and 258 of the 291 proposed sub-steps associated with CPB skills were accepted as integral to skill performance. By surveying practicing pediatric perfusionists, this study identifies 22 skills as fundamental to the safe execution of pediatric CPB. In addition, skill sub-elements were identified as necessary for skill execution. This knowledge will assist perfusion programs in developing a pediatric simulation curriculum that matches current clinical execution of pediatric skills.
The number of patients awaiting kidney transplantation has more than doubled in the past decade w... more The number of patients awaiting kidney transplantation has more than doubled in the past decade while the number of available donor organs has seen only a modest increase, leading to a critical shortage of organs. In response to this extreme shortage, the criteria for accepting organs have been modified to include marginal donors such as non-heart beating donors (NHBD). In these kidneys, determining viability is important for success of transplantation. Therefore, a study was undertaken to develop a system that would allow the extra-corporeal assessment of function and compatibility of the donor organ before the patient is exposed to the risks associated with surgery. Following bilateral nephrectomy, the kidneys of 10 pigs (~30 kg) were connected to a commercially available hypothermic pulsatile kidney perfusion apparatus. This system was modified to allow for normothermic pulsatile renal perfusion using the potential recipient’s blood, via vascular access. These kidneys were perfused with the animal’s blood for a minimum of two hours while various parameters were monitored. Perfusion pressures were kept between 60 and 90 mmHg, which correlated to flows between 70 and 150 mL/min. A decrease in perfusion pressure with a concomitant rise in flow over the two-hour period served as a good predictor of a viable and compatible graft. The modified kidney preservation system allows the normothermic, pulsatile extracorporeal perfusion of donor kidneys with the ability to monitor resistance to flow and urine production. This model also allows observation of the kidney for signs of hyperacute rejection. Further research needs to be conducted in order to determine if the system represents a methodology to increase the pool of available donor organs.
Cell phone use in the U.S. has increased dramatically over the past decade and text messaging amo... more Cell phone use in the U.S. has increased dramatically over the past decade and text messaging among adults is now mainstream. In professions such as perfusion, where clinical vigilance is essential to patient care, the potential distraction of cell phones may be especially problematic. However, the extent of this as an issue is currently unknown. Therefore, the purpose of this study was to (1) determine the frequency of cell phone use in the perfusion community, and (2) to identify concerns and opinions among perfusionists regarding cell phone use. In October 2010, a link to a 19-question survey (surveymonkey.com) was posted on the AmSECT (PerfList) and Perfusion.com (PerfMail) forums. There were 439 respondents. Demographic distribution is as follows; Chief Perfusionist (30.5%), Staff Perfusionist (62.0%), and Other (7.5%), with age ranges of 20-30 years (14.2%), 30-40 years (26.5%), 40-50 years (26.7%), 50-60 years (26.7%), >60 years (5.9%). The use of a cell phone during the performance of cardiopulmonary bypass (CPB) was reported by 55.6% of perfusionists. Sending text messages while performing CPB was acknowledged by 49.2%, with clear generational differences detected when cross-referenced with age groups. For smart phone features, perfusionists report having accessed e-mail (21%), used the internet (15.1%), or have checked/posted on social networking sites (3.1%) while performing CPB. Safety concerns were expressed by 78.3% who believe that cell phones can introduce a potentially significant safety risk to patients. Speaking on a cell phone and text messaging during CPB are regarded as "always an unsafe practice" by 42.3% and 51.7% of respondents, respectively. Personal distraction by cell phone use that negatively affected performance was admitted by 7.3%, whereas witnessing another perfusionist distracted with phone/text while on CPB was acknowledged by 33.7% of respondents. This survey suggests that the majority of perfusionists believe cell phones raise significant safety issues while operating the heart-lung machine. However, the majority also have used a cell phone while performing this activity. There are clear generational differences in opinions on the role and/or appropriateness of cell phones during bypass. There is a need to further study this issue and, perhaps, to establish consensus on the use of various communication modes within the perfusion community.
The ideal location of air bubble detector (ABD) placement on the cardiopulmonary bypass (CPB) cir... more The ideal location of air bubble detector (ABD) placement on the cardiopulmonary bypass (CPB) circuit is debatable. There is, however, very little data characterizing the prevalence of specific ABD placement preferences by perfusionists. Therefore, the purpose of this study was to survey the perfusion community to collect data describing the primary locations of air bubble detector placement on the CPB circuit. In June 2011, an 18-question on-line survey was conducted. Completed surveys were received from 627 participants. Of these, analysis of the responses from the 559 certified clinical perfusionists (CCP) was performed. The routine use of ABD during CPB was reported by 96.8% of CCPs. Of this group, specific placement of the bubble detector is as follows: distal to the venous reservoir outlet (35.6%), between the arterial pump and oxygenator (3.8%), between the oxygenator and arterial line filter (35.1%), distal to the arterial line filter (ALF) (23.6%), and other (1.8%). Those placing the ABD distal to the venous reservoir predominately argued that an emptied venous reservoir was the most likely place to introduce air into the circuit. Those who placed the ABD between the oxygenator and the arterial line filter commonly reasoned that this placement protects against air exiting the membrane. Those placing the ABD distal to the ALF (23.6%) cited that this location protects from all possible entry points of air. A recent false alarm event from an ABD during a case was reported by 36.1% of CCPs. This study demonstrates that the majority of CCPs use an ABD during the conduct of CPB. The placement of the ABD on the circuit, however, is highly variable across the perfusion community. A strong rationale for the various ABD placements suggests that the adoption of multiple ABD may offer the greatest comprehensive protection against air emboli.
Serious complications during the performance of cardiopulmonary bypass (CPB) are an infrequent ev... more Serious complications during the performance of cardiopulmonary bypass (CPB) are an infrequent event. However, when potentially fatal technical complications, such as oxygenator or pump failure, do occur, it necessitates a swift and well-coordinated response. Periodic performances of drills that simulate various CPB crises are a way to improve individual perfusionist proficiency during disaster situations. The purpose of this study is to determine the utilization of crisis management drills in perfusion departments. Every open-heart program listed by the American Hospital Association in the New England states (Maine,
The dramatic increase in the use of extracorporeal membrane oxygenation (ECMO) over the last deca... more The dramatic increase in the use of extracorporeal membrane oxygenation (ECMO) over the last decade with the concomitant need for ECMO competent perfusionists has raised questions of how well perfusion education programs are preparing entry-level perfusionists to participate in ECMO. While all perfusion schools teach ECMO principles, there is no standardized or systematic approach to the delivery of didactic knowledge and clinical skills in ECMO. Given this variability of ECMO education across and within perfusion schools, the CES-A exam may provide a metric for comparing curricular approaches. The purpose of this study is to examine three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We examined three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We hypothesized that there would be no difference in CES-A pass rate, exam score, Rasch measure, and item category scores between SUNY Cardiovascular Perfusion Program (CVP) graduates who completed SUNY's ECMO Capstone experience (Group III) and CVP graduates who did not select the ECMO Capstone experience (Group II). Further, we studied the performance of a third group of new graduates from an external program that does not offer formal ECMO courses or an ECMO Capstone experience (Group I). Every perfusion graduate in all groups passed the adult ECMO specialist exam. The graduates who as students completed an ECMO Capstone experience (Group III) scored higher on the exam and significantly higher on four exam categories: coagulation and hemostasis (p = .058), lab analysis point of care (p = .035), and monitor patient and circuit (p = .073), and the safety and failure modes (p = .017). Overall the median graduate Rasch measures ranked with Group III demonstrating the highest measure to Group I the lowest measures (not significant at p = .085). There is a positive educational effect due to CVP graduates completion of the ECMO Capstone experience compared to the program standard ECMO-related curricula in the two perfusion programs participating in this study. From this observation a structured ECMO simulation-based program appears to be equally effective as a traditional, typical lecture-only, clinical perfusion preceptorship, while demonstrating a more satisfactory experience with a higher reported case experience. In this study the standard perfusionist education curriculum prepared the new graduate to be successful on the CES-A exam. The three curricular approaches appear to prepare perfusionist graduates to be successful on the Adult ECMO Specialist exam.
The journal of extra-corporeal technology, Dec 1, 2014
Pressure data acquired from multiple sites of extracorporeal circuits can be an important paramet... more Pressure data acquired from multiple sites of extracorporeal circuits can be an important parameter to monitor for the safe conduct of cardiopulmonary bypass (CPB). Although previous surveys demonstrate that CPB circuit pressure monitoring is widely used, there are very little data cataloging specific applications of this practice. Therefore, the purpose of this study is to survey the perfusion community to catalog 1) primary CPB circuit site pressure monitoring locations; 2) type of manometers used; 3) pressure monitoring interface and servoregulation with pump console; and 4) the rationale and documentation associated with pressure monitoring during CPB. In June 2013, a validated 27-question online survey was sent directly through an e-mail link to the chief perfusionists in the northeast United States. Completed surveys were received from 75 of 117 surveys deployed yielding a 64% response rate. Arterial line pressure monitoring during CPB is reported by 99% with six distinct circuit site locations identified. Cardioplegia system pressure was monitored by 95% of the centers. For vacuum-assisted venous drainage (VAVD) users, the venous pressure was measured by 72% of the responding centers. Arterial line pressure servoregulation of the arterial pump was indicated by 61% of respondents and 75% of centers record arterial line pressure in their perfusion record. Most centers (77%) report the use of a transducer that is integrated into the pump console providing a digital pressure display, whereas 20% combine an aneroid gauge manometer with the integrated digital transducer. This study demonstrates that the practice of arterial line pressure monitoring during CPB is nearly universal. However, the selection of the pressure monitoring site on the circuit, modes of monitoring pressure, and their applications are highly variable across the perfusion community.
Despite the widespread use of vacuum-assisted venous drainage (VAVD) and case reports describing ... more Despite the widespread use of vacuum-assisted venous drainage (VAVD) and case reports describing catastrophic incidents related to VAVD, there is a lack of data cataloging specific safety measures that individuals and institutions have incorporated into their VAVD practices for the prevention of these incidents. Therefore, the purpose of this study is to survey the perfusion community to gather data on VAVD practices, and to compare these current practices with literature recommendations and the American Society of ExtraCorporeal Technology (AmSECT) Standards and Guidelines. In September 2014, a survey was distributed via PerfList and PerfMail, and by direct e-mail to members of the New York State Society of Perfusionists, targeting certified clinical perfusionists in New York State. Survey topics pertaining to VAVD practice included 1) equipment, 2) pressure monitoring and alarms, 3) protocols, checklists, and documentation, and 4) VAVD-related incidents. Of ∼200 certified clinical perfusionists who live and/or work in New York State (NYS), 88 responded (42%). Most respondents (90.1%) report they use VAVD. Of these, 87.3% report that they monitor VAVD pressure, with 51.6% having audible and visual alarms for both positive and excessive negative pressures. At the institutional level, 61.2% of respondents reported that there is a protocol in place at for their team limiting negative pressure in the reservoir, 28.4% document VAVD pressure in the pump record, and AmSECT's three recommended VAVD checklist items are met with 53.7%, 55.1%, and 33.8% compliance. In conclusion, the results of this study reveal that the use of VAVD has increased and has become nearly universal in 2014. There is high compliance to some of the literature recommendations and AmSECT Standards and Guidelines, however, there are still some gaps between current practices and these recommendations. Continued improvement, both at the individual and institutional levels, will help to improve patient safety by preventing untoward events from occurring while using VAVD.
Monitoring activated clotting time (ACT) during extracorporeal procedures is virtually universal.... more Monitoring activated clotting time (ACT) during extracorporeal procedures is virtually universal. The ACT test is usually performed immediately following blood collection. However, certain situations may occur that delay rapid measurement. It is unknown how an aged blood sample affects the ACT measurement. It is hypothesized that the ACT will be affected as a blood sample ages. Multiple blood samples were taken from six patients undergoing cardiopulmonary bypass (CPB). Samples were divided into two groups, heparinized (H) and unheparinized (UH). ACT/HMT tests were performed with each sample on eight devices (Array Actalyke, Gem PCL, Hemochron Jr. Signature, Hemochron Response, Hemochron 801, Hemotec HMS, Rapidpoint Coag, and Sonoclot II) at three different sample ages [< 60 s (fresh blood), 10 min, and 15 min after sample collection. ACT/HMT results of aged samples (10 min and 15 min after sample collection] were compared to ACT/HMT results for fresh blood using a repeated measures analyses of variance (ANOVA) with Student's-Newman-Keuls post hoc test. In the unheparinized group, no device produced an ACT significantly different from the fresh sample counterpart at the 10 min time point. At the 15 min time point, the Hemochron 801 produced a significantly lower average ACT when compared to the fresh sample. (120 +/- 25 vs. 135 +/- 5 s). In the heparinized group, the Actalyke device produced results with 10 and 15 min aged blood that were significantly longer than fresh blood sample results (ACT < 60 s = 426 +/- 66, 10 min = 457 +/- 82, 15 min = 450 +/- 68 s, p < .05). No other device produced significant differences for either time period. Based on this limited sample population, it seems that accurate ACT may be performed on blood samples up to 15 min old in many devices.
Introduction-Recirculation (R), the shunting of arterial blood back into to the venous lumen comm... more Introduction-Recirculation (R), the shunting of arterial blood back into to the venous lumen commonly occurs during veno-venous extracorporeal membrane oxygenation (VV-ECMO) and renders the monitoring of the venous line oxygen saturation no longer reflective of patient mixed venous oxygen saturation (S V O 2). Previously, we failed to prove the hypothesis that once R is known it is possible to calculate the S V O 2 of a patient on VV-ECMO. We hypothesize we can calculate S V O 2 while using VV-ECMO if we account for and add an additional correction factor to our model for dissolved oxygen content. Therefore, the purpose of this study is to derive a more accurate model that will allow clinicians to determine S V O 2 during VV-ECMO when ultrasound dilution is being used to quantify R. Methods-Using an extracorporeal circuit primed with fresh porcine blood, two stocks of blood were produced; (1) arterial blood (AB), and (2) venous blood (VB). To mimic recirculation, the AB and VB were mixed together in precise ratios using syringes and a stopcock manifold. Six paired stock AB/VB sets were prepared. Two sets were mixed at 20% R increments and 4 sets were mixed at 10% R increments. The partial pressure of oxygen (PO 2) and oxygen (O 2) saturation of the stock blood and resultant mixed blood was determined. The original model was modified by modeling the residual errors with linear regression. Results-When using the original model, as the partial pressure of arterial oxygen (P a O 2) of the stock AB increased the calculated S V O 2 was higher than actual, especially at higher R levels. An iteration of the original model incorporating the P a O 2 level (low, medium, high) and R was derived to fit the data. Conclusions-The original model using R and circuit saturations for the calculation of S V O 2 in VV ECMO patients is an oversimplification that fails to consider the influence of the high PO 2 of arterial blood during therapy. In the future, further improvements in this model will allow clinicians to accurately calculate S V O 2 in conjunction with recirculation measurements.
Pflügers Archiv: European Journal of Physiology, May 1, 1991
The Ca 2 +-gated Ca 2 § release channel of aortic sarcoplasmic reticulum (SR) was partially purif... more The Ca 2 +-gated Ca 2 § release channel of aortic sarcoplasmic reticulum (SR) was partially purified and reconstituted into planar lipid bilayers. Canine and porcine aorta microsomal protein fractions were solubilized in the detergent 3-[(3-cholamidopropyl)dimethylammonio]-l-propane sulphonate (CHAPS) in the presence and absence of 3[H]-ryanodine and centrifuged through linear sucrose gradients. A single a[H]-ryanodine receptor peak with an apparent sedimentation coefficient of 30 s was obtained. Upon reconstitution into planar lipid bilayers, the unlabelled 30 s protein fraction induced the formation of a Ca 2 § and monovalent-ion-conducting channel (ll0pS in 100mM Ca 2 § 360pS in 250 mM K+). The channel was activated by micromolar Ca 2 § modulated by millimolar adenosine triphosphate, Mg 2+ and the Ca2+-releasing drug caffeine, and inhibited by micromolar ruthenium red. Micro-to millimolar concentrations of the plant alkaloid ryanodine induced a permanently closed state of the channel. Our results suggest that smooth muscle SR contains a Ca 2 4_ gated Ca 2 § release pathway, with properties similar to those observed for the skeletal and cardiac ryanodine receptor/Ca 2+ release channel complexes.
Introduction. Some degree of recirculation occurs during venovenous extracorporeal membrane oxyge... more Introduction. Some degree of recirculation occurs during venovenous extracorporeal membrane oxygenation (VV ECMO) which, (1) reduces oxygen (O2) delivery, and (2) renders venous line oxygen saturation monitoring unreliable as an index of perfusion adequacy. Ultrasound dilution allows clinicians to rapidly monitor and quantify the percent of recirculation that is occurring during VV ECMO. The purpose of this paper is to test whether accurate patient mixed venous oxygen saturation (SVO2) can be calculated once recirculation is determined. It is hypothesized that it is possible to derive patient mixed venous saturations by integrating recirculation data with the ECMO circuit arterial and venous line oxygen saturation data. Methods. A test system containing sheep blood adjusted to three venous saturations (low-30%, med-60%, high-80%) was interfaced via a mixing chamber with a standard VV ECMO circuit. Recirculation, arterial line and venous line oxygen saturations were measured and entered into a derived equation to calculate the mixed venous saturation. The resulting value was compared to the actual mixed venous saturation. Results. Recirculation was held constant at 30.5 ± 2.0% for all tests. A linear regression comparison of “actual” versus “calculated” mixed venous saturations produced a correlation coefficient of R2 = 0.88. Direct comparison of actual versus calculated saturations for all three test groups respectively are as follows; Low: 31.8 ± 3.95% vs. 37.0 ± 6.7% (NS), Med: 61.7 ± 1.5% vs. 72.3 ± 1.8% (p &lt; 0.05), High: 84.4 ± 0.9% vs. 91.2 ± 1.1% (p &lt; 0.05). Discussion. There was a strong correlation between actual and calculated mixed venous saturations; however, significant differences between actual and calculated values where observed at the Med and High groups. While this data suggests that using quantified recirculation data to calculate SVO2 is promising, it appears that a straightforward derivative of the oxygen saturation-based equation may not be sufficient to produce clinically accurate calculations of actual mixed venous saturations. Perfusion (2007) 22, 239—244.
Departmental use of perfusion crisis management drills: 2002 survey results. Perfusion 2003;18:29... more Departmental use of perfusion crisis management drills: 2002 survey results. Perfusion 2003;18:299-303.] was a real eye-opener about how much we actually practice what we believe in these practice drills. There is a great deal of excellent information in what you have just shared here. We talk about an incidence rate of oxygenator failure as one in 4,500 patients and, in the back of our minds, we may think that is not a very high incidence. I will tell you, having had a failure accident in my center about ten years ago, when that one in 4,500 incident occurs, it really gets your attention. Shortly after that experience is when we started doing practice drills on a regular basis. You point out many benefits to them. The one thing you emphasized, which was really good, is the declaration of a problem. We practice what you have suggested and, when you start to see a failure, you will save precious time by declaring early. In the failure we had, we had a huge delay in the declaration of the problem. It was over ten minutes and we had difficulty communicating the problem. The normal reaction is that you are in denial, so I think it is very helpful to declare the problem immediately, once it is recognized. The other benefit I would point out from our experience in doing these drills is, if you have a written protocol when you do these drills, it is an excellent opportunity to refine that protocol and to find steps that you can take out so that the tasks can be accomplished more expeditiously. I think this approach makes a difference in the outcome for patients when there is an oxygenator failure. MR. STEVEN RASKIN (Houston, Texas): You bring up some of the things we may overlook as we stay in practice for a while. One of the things you mentioned is Perfusion 25(3) 144-145
Since recirculation during venovenous extracorporeal membrane oxygenation (VV ECMO) reduces oxyge... more Since recirculation during venovenous extracorporeal membrane oxygenation (VV ECMO) reduces oxygen delivery to the patient, monitoring recirculation is necessary to guide clinicians in interventions that may reduce recirculation and thereby optimize patient care. The use of dilutional ultrasound may be a clinically practical way to quantify recirculation during VV ECMO. This study evaluates in a swine model of VV ECMO a dilutional ultrasound techniques ability to provide accurate recirculation data under changing conditions. One 16-kg swine was cannulated with a dual-lumen cannula and placed on VV ECMO. Recirculation measured by using blood oxygen saturations (r = S(preox) - SVO2/S(postox) - SVO2) was compared with recirculation measured by a saline dilution ultrasound technique. Dilutional ultrasound was then used to measure changes in baseline recirculation in the face of (a) cannula repositioning and (b) a drug-induced cardiac output change. The comparison of recirculation calculations between the saturation method and dilutional ultrasound were similar at all flow rates measured. The time for results was much faster with the use of dilutional ultrasound. Induction of recirculation changes by repositioning the cannula or changing cardiac output was rapidly detected using dilutional ultrasound and showed significant differences from baseline recirculation. Dilutional ultrasound provides a clinically practical method to quantify and monitor recirculation in VV ECMO applications and may aid in assessing interventions to improve oxygen delivery.
Introduction: Training students to become entry-level perfusionists requires evaluation and asses... more Introduction: Training students to become entry-level perfusionists requires evaluation and assessment of their clinical skills. While our professional organizations have compiled resources which identify the profession's knowledge base and categorical skills applied to clinical practice, these resources are lacking the necessary detail to develop validated clinical assessment rubrics. Therefore, the purpose of this project is to identify, through expert opinion, the detailed fundamental skills necessary to perform adult cardiopulmonary bypass (CPB). Methods: We define a fundamental skill based upon frequency of use and risk of harm. A skill that experts report is conducted in >50% of their CPB cases-and, if not properly conducted, can cause harm, is deemed a fundamental skill. To identify these skills, a 73-question survey was developed and posted on PerfList and PerfMail from May 2017 to July 2017. Results: The results from 261 respondents were analyzed. The demographics of the participants were representative of the workforce. Twenty skills were surveyed and all 20 met the criteria to be identified as a fundamental skill. Data regarding the actions, assessments and behaviors that may be associated with fundamental skills were also identified. Conclusions: Based upon this survey data, we have identified that there is consensus within our profession regarding the fundamental skills of adult CPB and a core body of actions, assessments and behaviors that experts perform when conducting these skills. This information may be incorporated into the entry-level educational process to inform curricula and design valid assessment rubrics.
A survey by our department revealed that most of the institutions in New England and New York hav... more A survey by our department revealed that most of the institutions in New England and New York have written protocols for low-volume, high-risk, emergency events but few of these centers formally practice these protocols through simulation. We hypothesized that hands-on experience with medical emergency protocols will significantly improve clinician performance. Two groups (n = 24 each) of third semester perfusion students with comparable clinical skills were enrolled in this study. The first group was surprised with an emergent oxygenator change-out drill during a simulation exercise, with no prior warning and without the benefit of a written protocol. The second group was asked to develop a written protocol before they were challenged with the change-out drill. Subsequently, both groups were given a week to practice a protocol for emergent change-out before re-testing. The times for all change-out drills were recorded and the groups were compared with a Student&amp;amp;amp;amp;amp;amp;#39;s t-test. A p-value &amp;amp;amp;amp;amp;amp;lt; 0.05 was considered significant. The group without a written protocol (NP) had the longer time (559.7 +/- 84.9 sec) while the group with the written protocol (P) performed better (461.8 +/- 57.5 sec, p &amp;amp;amp;amp;amp;amp;lt; 0.05). However, both groups achieved significantly better performance following repeated practice (NP = 167.8 +/- 34.8; P = 170.9+/-32.5 sec, p &amp;amp;amp;amp;amp;amp;lt; 0 .05). While written protocols for emergent events will improve patient care, simulation and practice of emergency protocols is the most significant way to protect our patients. Based on this, we advocate for all perfusion groups to simulate emergency events and practice their crisis protocols.
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Papers by Edward Darling