Page 42 - ANZCP Gazette November 2021

AROUND THE PUMP ROOM
Kia ora from the ‘coolest little capital in the world’! Our perfusion team is fortunate to call Wellington home. The capital city of New Zealand is tucked between the hills and harbour creating a compact city with amazing views. Wellington has something for everyone whether it is meeting friends for kai at one of our many amazing restaurants, catching a rugby game at Sky Stadium, checking out the exhibitions at Te Papa, or exploring the vast landscapes and views from one of the many trails around the city. The population of Wellington City is only 215,000, but the small city charm is complemented by a rich culture of art, music, whānau, and food.
Capital & Coast District Health Board operates Wellington Regional Hospital. Our hospital is located in Newtown, a central suburb of Wellington. Cardiothoracic surgery is performed in two dedicated cardiac theatres. We have 5 clinical perfusionists and 5 cardiac surgeons. Our cardiothoracic service cares for patients from the bottom half of the North Island as well as from the upper tip of the South Island. Our hospital has 18 tertiary-level ICU beds, none of which are dedicated cardiac beds. We mostly do CABG and valve surgery, but we also perform many aortic repairs in a year. Our aortic cases are typically repaired in the branch-first technique where we utilize a secondary arterial pump to provide flow to the head independent from the body. Our newest surgeon has also brought her eagerness to add minimally-invasive mitral valve repairs to our catalogue of services. As soon as the borders open, we hope to do a site visit to one of the centres in Australia who already perform these procedures so that we may share knowledge.
We currently use Stockert S5 bypass machines, 3T heater coolers, and Sorin Xtra cell savers. Our pump packs are made by Medtronic. Our ACTs are measured by the Hemochron Signaure Elite. At our hospital, the perfusion department is also in charge of the blood gas machines for all of theatres. We have two Radiometer ABL90 units, one of which is on a mobile trolley which can be taken to the bedside in acute cases for rapid testing. The perfusion department also maintains and operates the two Haemonetic TEG 5000 units in the theatre department. The TEG is mainly used in cardiac surgery, but other specialties are beginning to find use of its benefits for haemostasis. Our anaesthetic department is in the process of adding a mobile TEG 6S to our fleet of machines. The TEG 6S seems much easier to operate than the TEG5000 for the casual user.
For cardioplegia, we mainly use a normothermic microplegia system. We make up the solution daily in a 60 mL syringe. The recipe consists of potassium, dextrose, magnesium sulfate, sodium bicarbonate, and saline. The cardioplegia is controlled by a syringe driver which infuses the contents via 3-way tap into
a 1⁄4” blood-filled line coming off the oxygenator. The 1⁄4” line is controlled by a small pump head to deliver the cardioplegia at the proper flow rate. We do have a heat exchanger in the circuit, but we only use it if we struggle getting the heart arrested. Otherwise the cardioplegia is delivered at the same temperature the patient has been set to.
For our longer cases, we have just begun to use Custodiol. It took a long time to get the surgeons comfortable with an alternate cardioplegia solution. We will begin to look at Del Nido as a third option.
Over the last year and a half, we have begun using the Cytosorb adsorber quite regularly. We originally began using the device for acute CABGs who had been given Ticagrelor and/or Rivaroxaban within three days of surgery. Since then, we have begun taking advantage of its cytokine removal and other anti- inflammatory effects for patients suffering from endocarditis or who are requiring an acute aortic dissection repair. Its use has become a very popular request by our surgeons.
I have been in Wellington for just over 10 years. As soon as I entered theatre to be introduced to the team, I knew this would be my forever home. Everyone was so nice and welcoming. I went to perfusion school in Milwaukee, Wisconsin and graduated in 2005 with a Master’s of Science in Perfusion. I took my first job in Greenville, North Carolina, and I worked there for 6 years before I sold everything and moved to New Zealand. After a couple of years and a couple of retirements, I was promoted to Chief Perfusionist. The perfusion team has changed completely since I moved here, but has been stable since 2017.
Val Haripershad joined our team originally as a locum but became a permanent fixture in August 2015. She originally hails from South Africa but has lived many years in Hamilton, NZ before permanently joining our team.
Andy Hickman trained and worked in Bristol, UK before moving here in November 2015. He brought his knowledge on how to hire and work with perfusion trainees successfully. We have since hired and trained one trainee to program completion.
Johnny Fitzgerald joined our team in August 2016. He trained and worked in Plymouth, UK before moving to Perth to work for a while. After his time in Western Australia, he jumped the ditch to work with us in Wellington.
James Holder is our third team member from the British Isles and the second team member who has trained and worked in Bristol, UK. His block of experience in Bristol was divided in two by an 18 month contract with the perfusion group in Auckland. The experience left him with such fond memories of
Amber Blakey CCP, FANZCP Wellington Regional Hospital, New Zealand
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39 NOVEMBER 2021 | www.anzcp.org