January/February 2016 Volume 19 Issue 1 MESSAGE FROM THE PRESIDENT. We Stand on the Shoulders of Countless People

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1 CALENDAR OF EVENTS January 1-April 1 Applications accepted for the Fellow of Pediatric Perfusion designation. Request an application before March 1. Requirements here: 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 AmSECT s 54th International Conference, The Broadmoor Resort, Colorado Springs CO featuring workshops, GDT Symposium and keynote speakers. ld/fid=1203 September AmSECT s Quality and Outcomes, Sheraton New Orleans, New Orleans LA. Visit for additional information. AmSECT January/February 2016 Volume 19 Issue 1 MESSAGE FROM THE PRESIDENT 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 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. oday There is one group I do not talk about much in my president s messages that I am Jeffrey B. Riley MHPE CCT CCP 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 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. DIGITAL TABLE OF CONTENTS What s Inside 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 AmSECT Election Candidates... Upcoming AmSECT Meetings... From My Time in the Trenches... Self Quiz Answers... Broken Hearts... Thanks to our Sponsors... Student View Point...

2 Page 2 AmSECT Today - January/February 2016 THE INNOVATIVE AND INTUITIVE TM CONNECT PERFUSION CHARTING SYSTEM Efficient data transfer for traceability and reporting Real-time data recording and trends visualization Integrated metabolic monitoring supporting Goal-Directed-Perfusion Customizable user interface delivering enhanced flexibility TM CONNECT TM GDP MONITOR TM HEARTLINK CARD XTRA S5 TM INSPIRE TM TM HEARTLINK SYSTEM Data management and system integration redefined. The HeartLink System is a comprehensive and powerful cardiopulmonary solution that allows complete data transfer and integration through the Connect perfusion charting system. Connect is a combination of advanced software applications and integrated hardware tools that provide efficient and effective support for your practice and documentation goals. Connect assists with data management during and after Cardiopulmonary Bypass (CPB). IM-00513/A Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. Trademark used herein are owned by or licensed to LivaNova USA, Inc.

3 AmSECT Today - January/February 2016 Page 3 EDITOR S NOTE 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. AmSECT s NATIONAL OFFICE 330 N. Wabash Avenue Suite 2000 Chicago, Illinois Phone (312) Erin Butler Executive Director ebutler@amsect.org Vince Leibold Operations and Administration vleibold@amsect.org Perry Juliano Event Services pjuliano@amsect.org Megan Laatsch Education and Learning Services mlaatsch@amsect.org Rebecca Baker Exhibits and Sponsorship rbaker@amsect.org Jennifer Snider Marketing and Communications jsnider@amsect.org Tissy Greene Membership Manager tgreene@amsect.org 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 trusk@kent.edu amsectu.org

4 Page 4 AmSECT Today - January/February 2016 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 trusk@kent.edu 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 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 Advertising rates and related details are available upon request by contacting the above address, ing rbaker@amsect.org or calling (312) 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. By Mat Medlin RRT BS CCP LP Savannah, Georgia THEME ARTICLE Safe ECMO Transport 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

5 AmSECT Today - January/February 2016 Page 5 THEME ARTICLE central venous pressures, continuous end-tidal CO 2 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. WELCOME NEW MEMBERS Active Reginald Ballard CCP...Alexandria, VA 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 Associate Aaron Splint BS...Falmouth, ME International Sandra S. Gibb CCP...St. Andrews, MB, Canada Student Melat Bikila...UPMC Shadyside 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 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 AmSECT Today Themes January/February Extended Life Support - Transport Medicine AmSECT International Conference Promotion March/April May/June Pharmacology - Myocardial Preservation AmSECT International Conference 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/ Professionalism - Perfusion Education - October Adjunctive/Ancillary Perfusion Responsibilities November/ December Join your colleagues to hear: President s Address State of the Society Election Results 2016 Strategic Plan Treasurer s Report New Business For more information and to register, visit Emergency Preparedness - Emerging Technology Quality and Outcomes Summary

6 Page 6 AmSECT Today - January/February 2016 AmSECT MANAGEMENT CHANGE Dear Members, New AmSECT Office Open for Business in Chicago Meet your Headquarters Team! 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 Phone: (312) FAX: (312) amsect@amsect.org Websites: If you have any questions, please reach out to your new staff team: NAME TITLE Erin Butler Executive Director ebutler@amsect.org Vince Leibold Operations and Administration vleibold@amsect.org Perry Juliano Event Services pjuliano@amsect.org Megan Laatsch Education and Learning Services mlaatsch@amsect.org Rebecca Baker Exhibits and Sponsorship rbaker@amsect.org Jennifer Snider Marketing and Communications jsnider@amsect.org Tissy Greene Membership Manager tgreene@amsect.org 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, Jeffrey B. Riley MHPE CCT CCP President

7 AmSECT Today - January/February 2016 Page 7 AmSECT NATIONAL AWARDS 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 Gibbon Award 2016 Nominees Cynthia P. Cervantes CCP Barry University Pedro J. del Nido MD Boston Children s Hospital Craig R. Vocelka CCP MDiv University of Washington 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. Perfusionist of the Year 2016 Nominees Ashley B. Hodge MBA CCP FPP Nationwide Children s Hospital Cynthia P. Cervantes CCP Barry University William J. DeBois CCP MBA New York Presbyterian Hospital 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 Cynthia P. Cervantes CCP Barry University William J. DeBois CCP MBA New York Presbyterian Hospital Susan J. Englert RN CCP CPBMT President, Perfusion Services LLC 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 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 Dawn M. Oles MHPE CCP LP Mayo Clinic

8 Page 8 AmSECT Today - January/February 2016 ************ AmSECT 2016 CANDIDATES ********** AmSECT Online Ballot Open January 17, 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 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.

9 AmSECT Today - January/February 2016 Page 9 ************ AmSECT 2016 CANDIDATES ********** 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, Smith- Bucklin, 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 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 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 opportunity to transform the department into a thoroughly modern pediatric perfusion program, using the latest equipment and procedures. I worked with our team to continuously improve techniques and results, making advances in patient outcomes, and working with others on the heart team to publish the results of our efforts. Last year our program became a clinical site for students from MUSC and Midwestern University. Interest in Running: AmSECT has helped me in my career, and I want to pay it forward and continue the work that our society has done - Continued on next page - 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 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 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. Director Zone 2 Tammy Haga-Greco Biographical Statement: I graduated from the Medical University of South Carolina s perfusion program in Since that time, I have worked in St. Louis, Missouri primarily as a pediatric perfusionist. From , while I was working on my CCP, I did both adult and pediatric patients. Since 1996, I have worked primarily in a children s hospital and the adult patients I see are adult congenital cases. At present, I work for Saint

10 Page 10 AmSECT Today - January/February 2016 ************ AmSECT 2016 CANDIDATES ********** 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 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: AmSECT Today, Editor-in-Chief; International Conference Planning Committee Member; Strategic Planning Committee; AmSECT Today, Associate Editor; International Conference Planning Committee Member; Membership Committee Member; Achievement Recognition Committee Chair; Achievement Recognition Committee Member; 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 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 Coordinator- ECMO, chief-mechanical Research and- Support 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 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 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

11 AmSECT Today - January/February 2016 Page 11 ************ AmSECT 2016 CANDIDATES ********** 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 Biographical Statement: I graduated with a Masters in Cardiovascular Science from Midwestern University in 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. Achievement Recognition Committee Chrysta Terenzi Biographical Statement: My name is Chrysta Terenzi and I am a graduate of the C.W. Post Long Island University Perfusion Program. During my time at school, I was elected class representative, and awarded most professional. I am currently approaching my third year as a board-certified perfusionist at New York Presbyterian Columbia Hospital and was selected to begin in the pediatric perfusion department in March As a student I was an AmSECT speaker, having given a presentation pertaining to Veno-Veno-Venous-Arterial ECMO. More recently, this past April I attended the AmSECT meeting in Tampa, and I am looking forward to attending this year s meeting. Interest in Running: I am running for Achievement Recognition Committee Member because I want to be more immersed in the decision making of AmSECT. I think it s important that we promote personal accomplishments and milestones within the perfusion community. As I progress in my career at Columbia, it has enabled me to recognize all of 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. Achievement Recognition 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 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 in Biochemistry (BS) and Chemistry (BA) from the University of Minnesota. She attended perfusion school at Vanderbilt University Medical Center s Cardiovascular Perfusion Technology program. During perfusion school Molly presented at several meetings (both poster and scientific) on ABOincompatible heart transplants, a case report on ECMO post MVR, and Ex Vivo Lung Perfusion. Molly graduated in May 2014 from Vanderbilt and began working at Boston Children s Hospital as a pediatric and congenital perfusionist. Molly has helped develop three classes for AmSECT University; Review Course-Perfusion Methodologies: Pediatrics I & II, and ABO-Incompatible Heart Transplants. She hopes to continue her collaboration with AmSECT and AmSECT University. Interest in Running: Molly Hageman is requesting to be considered for the AmSECT Bylaws committee. New graduates are the next generation in perfusion. As a new graduate myself, I believe that we should take a more active role in our societies and I think that it s essential to understand the interworking of the society; such as the bylaws. As a recent graduate, I can bring a fresh set of eyes and unique experiences to the Bylaws com- the advances we take part in within the perfusion profession. I have the mittee that might aid AmSECT as it continues to grow. I am a very well - Continued on next page -

12 Page 12 AmSECT Today - January/February 2016 ************ AmSECT 2016 CANDIDATES ********** Continued from page 11 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. Nominating Committee 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) Washington Hospital Center per diem ECMO coverage - Washington, DC Cleveland Clinic - Cleveland Ohio Cleveland Clinic Abu Dhabi - Abu Dhabi, UAE present AmSECT Experience: - Meeting Attendance 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. Nominating Committee 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 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.

13 AmSECT Today - January/February 2016 Page 13 FROM MY TIME IN THE TRENCHES What Will You Do After Your Perfusion Career Ends? By Gary Grist RN CCP Retired and Stacy Bllythe RN PhD I retired in December 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 ( )? 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, garygrist@comcast.net. 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 Dec;36(4): Contact Tissy Green with your Membership Questions tgreene@amsect.org

14 Page 14 AmSECT Today - January/February 2016 Emerging Technology: My First HeartMate 3 Experience By Laura Rigg CCP University of Rochester Medical Center BROKEN HEARTS 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 levels 1 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 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 x 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

15 AmSECT Today - January/February 2016 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: / PCC.0b013e e4. 2. Lequier L, Annich G, Al-Ibrahim O et al. ELSO Anticoagulation Guideline. Extracorporeal Life Support Organization Available at: elso.org/portals/0/files/elsoanticoagulationguideline table-contents. pdf. Accessed December 28, Oliver W. Anticoagulation and Coagulation Management for ECMO. Seminars in Cardiothoracic and Vascular Anesthesia. 2009;13(3): doi: / 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): doi: / MAT.0b013e a. 5. Coughlin M, Bartlett R. Anticoagulation for Extracorporeal Life Support: Direct Thr.: ASAIO Journal. LWW Available at: com/asaiojournal/abstract/2015/11000/anticoagulation_for_extracorporeal_life_support.6.aspx. Accessed December 29, Imagine the Possibilities... AmSECT University

16 Page 16 Viewpoint AmSECT Today - January/February 2016 STUDENT 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!

17 AmSECT Today - January/February 2016 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: UC EN 2015 Medtronic, Inc. All Rights Reserved.

18 ? Page 18 AmSECT Today - January/February 2016 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 d. None of the above 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 d. None of the above 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 d. None of the above Answers to Quiz on page

19 AmSECT Today - January/February 2016 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 d. None 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 d. None of the above 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 d. None of the above 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 Imagine the Possibilities... AmSECT University Perfusion Review Class Now Available! 35 hours of new study material! 15. Increasing MAP during CPB with phenylephrine instead of increasing pump flow compromises splanchnic perfusion. a. True b. False 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, trusk@kent.edu 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!

20 Page 20 AmSECT Today - January/February 2016 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 Julie Wegner completed her doctorate in physiology from the University of Arizona in May She received her perfusion education at the University of Arizona in August 1992 and mastered her ABCP exams in Julie was a staff perfusionist at University Medical Center in Tucson from 1992 to 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 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 In regard to JECT, Julie has been an associate editor since 2000 and has served as an editorial advisor to Robert Groom since 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

21 AmSECT Today - January/February 2016 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 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 Full articles, PDFs and figures my be downloaded for free. Exciting news! How do I access it? Visit to download JECT issues older than six months. JECT can also be found by conducting a search on PMC.

22 Page 22 AmSECT Today - January/February 2016 PEDIATRIC PERFUSION Little Hearts By Kellen Goldberg MPS CCP Staff Perfusionist, Clinical Coordinator Children s Hospital of Alabama Exit to ECMO Kellen Goldberg MPS CCP 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, 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 SaO Take to cath lab for a balloon atrial septostomy SaO2 < 50 Exit to ECMO and take to cath lab for a balloon atrial septostomy

23 AmSECT Today - January/February 2016 Page 23 Foundation Donors as of December 28, 2015 Honors Circle Donations $2,000 and Above Lee Bechtel Colette S. Calame BS CCP FPP Tyler Samolyk, Global Blood Resources Missouri Perfusion Society 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 Jeffrey B. Riley MHPE CCT CCP 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 F O U N D A T 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 I O N Patron Donations up to $249 Thomas G. Steffens MPS CCP LP FPP Catherine H. Taylor CCP Craig R. Vocelka CCP MDiv

24 Page 24 AmSECT Today - January/February 2016 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 Evidence- Based 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. This month, I d like to talk about Shahna L. Bronson CCP 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 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

25 AmSECT Today - January/February 2016 Page 25 Figure 6 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, CO 2 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

26 Page 26 AmSECT Today - January/February 2016 R EGIS TER NOW!

27 AmSECT Today - January/February 2016 P L A N NOW TO ATTEND! Page 27

28 Page 28 AmSECT Today - January/February 2016 President s Message Continued from page 1 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, 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 SELF-QUIZ ANSWERS Jeff Amendola Josh Blessing Kathryn Levenick Marvin Gohman Mathew Schuldes Phil Scott Shu Li Timothy Dickinson Zhen Ren Amanda Cornelius 1. d 2. c 3. d 4. b 5. a 6. c 7. d 8. c 9. d 10. a 11. c 12. c 13. b 14. a 15. a Self Quiz can be found on page 18. THANKS TO OUR CORPORATE SPONSORS 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. AmSECT Website Sponsor Thoratec Corporation AmSECT App Sponsor Medtronic Breakfast Sponsor Spectrum Medical Dinner Symposium Sponsor MAQUET Speakers Reception Sponsor MAQUET Charging Station Sponsor MAQUET Water Station Sponsor MAQUET CAPS/B. Braun (Central Admixture Pharmacy Services, Inc.) CardiacAssist, Inc. CASMED Global Blood Resources Helena Laboratories EXHIBITORS Award of Excellence Sponsor NFO Healthcare Industry Insurance Services, Inc. Perfusionist of the Year Sponsor Medtronic Scholarship Contributors NFO Healthcare Industry Insurance Services, Inc. Terumo Cardiovascular Group MicroAire Surgical Instruments, LLC NFP Healthcare Industry Insurance Services, Inc. revo Biologics

29 AmSECT Today - January/February 2016 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 Ottens J, et al. Improving Cardiopulmonary Bypass: Does Continuous Blood Gas Monitoring Have a Role to Play? Journal of Extra-Corporeal Technology, 2010; 42: 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: Terumo Cardiovascular Group Ann Arbor, Michigan USA Terumo is a registered trademark of Terumo Corporation. CDI is a registered trademark of Terumo Cardiovascular Systems Corporation Terumo Cardiovascular Systems Corporation. May