Page 48 - ANZCP Gazette MAY 2014

PERFUSION IN THE 21ST CENTURY –
A GERMAN PERFUSIONIST PERSPECTIVE
Alois Philipp ECCP and Christoph Benk* ECCP, Dipl.Ing.
University Hospital Regensburg, University Hospital Freiburg, Germany, Franz Josef Strauss Allee 11, D-93053 Regensburg, Germany
Germany has a population of 82.2 million people. The first successful extracorporeal circulation was conducted on 18 February 1958 by Zenker in Marburg, Germany. In its earliest days, implementation of the heart-lung machine was performed by surgeons. In the last decade, 95.000-100.000 cardiac surgeries with support from extracorporeal circulation are performed yearly. In addition, we have around 2000 ECMO treatments per year.
Today there are 82 cardiac centers working in Germany. There are 500 active Perfusionists, of which 30% have a close within medical engineering. Basically, there is no statutory provision for the activity of Perfusionists. However, in most institutions,
ECCP as a minimum level of education is requested for Perfusionists in Germany. 85% of Perfusionists are organized in the German Society of Perfusionists.
Currently, there is no increasing need for Perfusionists in their classic field of cardiac surgery. However, increasing demands in fields outside cardiac surgery open up new opportunities for Perfusionists, such as specializations within ECMO support, medical engineering or technological electrophysiology.
Future Perfusionists will increasingly be assigned to new tasks beyond the implementation of extracorporeal circulation, which originally was their field of work.
‘TO PREWARM, OR NOT TO PREWARM?’
THAT IS THE QUESTION!
Rona Steel and Adam Hastings
Westmead Public Hospital, Hawkesbury Rd, Westmead, NSW, 2145.
Complications of intraoperative hypothermia have been well documented to increase mortality and morbidity (1) (2). After an audit on ICU arrival temperatures for 88 consecutive cardiac bypass patients at our institution, we were concerned to discover that 80% of our patients arrived in ICU with a nasopharyngeal (NP) temperature <36°C. After analysing the data, testing for many possible causes, the only factor with even slight significance was the patient’s NP temperature at the commencement of bypass. 67% of our patients commenced bypass with a NP temperature <35°C.
In a subsequent audit we documented the ICU arrival temperature of 35 patients that had been prewarmed with a forced-air warmer prior to bypass and had a fluid warmer post bypass. These patients arrived in ICU much warmer, with 55% arriving ≥36°C for all comers including DHCA. A possible mechanism to explain this observation might be that their thermoregulatory vasoconstriction is reduced, especially in
patients between 34-35°C(3). Thus, we can better manage their temperatures on bypass and rewarm them more uniformly.
In conclusion, there appears to be an association between prebypass patient temperature with the use of fluid warmers post bypass and ICU arrival temperatures. The more normothermic the prebypass temperature, the more normothermic ICU arrival temperature and thus improved patient outcomes.
References
1. Sessler,D.I(2001). Complications and Treatment of Mild Hypothermia. Anaesthesiology 95:531-43
2. Kirkbride,D.A. Buggy,D.J(2003). Thermoregulation and Mild Perioperative Hypothermia. British Journal of Anaesthesia 3(1)24-28.
3. Sessler,D.I(2000). Perioperative Heat Balance. Anaesthesiology 92:578-96
46 MAY 2014 | www.anzcp.org