Page 40 - ANZCP Gazette-August-Booklet

AROUND THE PUMP ROOM
Peter Frantzis CCP, FANZCP, Royal Adelaide Hospital, South Australia
In May 2020, a milestone was reached in the Cardiothoracic Unit, with the total number of bypass cases performed at the New Royal Adelaide Hospital (N-RAH) reaching 1500 cases. Following many years of planning and preparation of the N-RAH, the move in September 2017 proved rather challenging and interesting. Nevertheless, the move was well overdue, given the working environment in the Cardiothoracic Unit at the N-RAH was considerably more spacious and pleasurable, with updated equipment and facilities.
The Cardiothoracic Unit was first established at the RAH by the late Dr Hamilton D’Arcy Sutherland in the early 1960s. From this time, over 35,000 bypass cases, including pediatric cases in the early 1990s, were performed at the RAH. In the process of moving to the N-RAH, historical items that were hidden away were discovered. Such items included blueprints, photographs, price lists, information booklets of the former Melrose heart lung machine and clinical documentation.
With regards to the COVID-19 pandemic, being the state’s designated hospital for handling the outbreak meant we had to quickly plan and prepare for what COVID-19 would bring. As a result, we had to increase stock levels to prepare for any shortages in consumables. In addition, one of our two CTSU technical suites had to be converted into a COVID-19 technical suite. All members of the Perfusion team were required to undergo PPE training, various mask fittings and separation protocols to limit direct contact with other members. A total of 18 COVID-19 positive patients were treated in the ICU unit, with eight patients requiring ventilation and, sadly, four patients passing away. Surprisingly, none of the COVID-19 positive patients in ICU had to be put on VV or VA ECMO.
Images L to R: Items discovered during the move to the N-RAH, including photographs of the first bypass, a Melrose HLM price list from 1962 and old information booklet about the Melrose heart-lung machine.
The greatest challenge for the Cardiothoracic Unit in moving to the N-RAH included incorporating the point-of-care clinical information perfusion system ‘Metavision’, which is supplied by Getinge. As expected, introducing a new perfusion software system on a new hospital network server proved difficult and took some time, especially in terms of connecting external clinical devices. However, this difficulty was further accentuated by the lack of guidance in incorporating the system, given we are the only users of Metavision in Australia. As a result, we are continually working with Getinge engineers in Germany to overcome any difficulties and to improve the system. Working with the engineers in Germany will bring changes to our unit over the next few months. These changes include the introduction of the new HL-40s and the trial of a quality assurance program provided by iMDsoft, in association with Metavision.
The Perfusion team continues to be involved with Hyperthermic Intraperitoneal Chemotherapy procedures (HIPEC) at the Queen Elizabeth Hospital, which have been performed by Professor Peter Hewett since 2007. More than 180 of these cases have been performed for the treatment of predominantly pseudomyxoma peritonei and mesothelioma. Currently we are using the Belmont hyperthermia pump. This pump has proven to be a more compact and reliable device for these complex procedures and has eliminated the usage of any heater cooler units in the operating theatre environment.
Moving forward, the Perfusion team will soon be involved in an ascending and aortic root porcine study at the SAHMRI- PIRL Gillies Plain facilities next month.
37 SEPTEMBER 2020 | www.anzcp.org