Around the (Distant) Pump Room by Martin Gill, CCP.
An AMAZING Perfusion Publication ! (Contact Martin on how to Subscribe)
Media Journalism by…
Martin Gill: Perfusionist
Editor (former), ANCZP Gazette
email for subscription: [email protected]
(Children’s Hospital at Westmead, Sydney Australia)
Editor’s Note:
Martin Gill is a gifted writer and supporter of perfusion international relations and improving perfusion practice- wherever it may be.
He has submitted several “Live Blogs: of prior perfusion conferences “Down Under” (Australia)
He needs no further introduction- as he very capably demonstrates in his story below:)
Thank you Martin 🙂
Whilst my primary role in my professional life is that of a paediatric perfusionist at the Heart Centre for Children, Sydney, Australia; I was also the editor of the Australian and New Zealand College of Perfusionists Gazette.
The Gazette is a twice yearly publication for Perfusionists in Australia and New Zealand consisting of general perfusion news, letters, opinions, case reports, original articles etc etc.
One regular feature within The Gazette is ‘Around the Pump Room’. This is essentially a brief article that gives perfusionists from various centers throughout the region to share with the community what they are up to professionally or indeed otherwise.
This year we took the feature on the road and thought we would share it with our friends at ‘surfers’. I hope you enjoy it…..
Around the (Distant) Pump Room
by Martin Gill, CCP.
For this edition of ‘Around the Pump Room’ we are going to break with tradition slightly by taking this feature ‘on the road’. This edition of ‘Around the Pump Room’ is coming from Great Ormond Street Hospital for Children (GOSH), London, UK. In January this year I was fortunate enough to spend a week with the GOSH perfusion team. The team is made up of 4.5 full time equivalent perfusionists plus one trainee perfusionist. They cover 2 cardiac theatres 5 days per week and have a limited involvement in the reasonably active ECMO program. Besides routine cardiac surgery, GOSH have a heart and lung transplant program, with associated VAD program.
The perfusion office, as seems to be the norm in most hospitals (apart from my own) is within the theatre complex. The start of the day is no different from any other for the perfusionist with one notable exception; at approximately 0830 each morning the perfusionist, surgeons, anaesthetist, theatre nurses, cardiologist and intensivist have what is referred to as a ‘group hug’. This is actually a brief meeting discussing the day’s cardiac list. Following everyone introducing themselves, each party is given opportunity to give input into the pre, intra and post-operative plan for the patients in the cardiac theatre that day. Once complete it is back to business. I felt that this ‘group hug’ was a great idea, especially getting the intensive care team actively invested in the care of the patient from the pre-operative phase.
The cardiac theatres in GOSH are all newly built. There are two dedicated cardiac operating rooms plus a hybrid theatre. The operating rooms are fairly large with three video displays. Also available is a video link and two way audio to a conference room for teaching purposes and for when a large amount of visitors are in town.
The pre-operative ‘time-out’ is also slightly more involved than I am used to. Before the time out can commence a perfusionist, anaesthetist, surgeon and scrub nurse must be present. Besides checking the patient details are correct, once again each profession is given time to have input. The surgeon describes in detail his operative plan; the anaesthetist describes his plan for the immediate postoperative course. The perfusionist details his cannula choice, and changes to normal perfusion practice for the particular case, and also if he plans to carry out MUF. Once again I was quite taken with this attention to detail. This process ensured that each part of the team was fully aware of the plan and projected course of the patient.
With regard to perfusion hardware and disposables only a few differences took me by surprise. The team at GOSH did not utilise an arterial line filter within the bypass circuit and nor did they use a pre bypass filter. The lack of either of these devices was primarily due to a lack of belief in the benefit of either when weighed against the potential addition to circuit prime and cost. Each heart lung machine had mounted on it a GAMPT microemboli counter for use if the perfusionist so desired. These devices were used on every case by one of the perfusionists who then printed out a report and placed it in the perfusion record which went in the patients notes. The other perfusionists only used this device occasionally. One advantage of the GAMPT in comparison to the EDAC (which I admittedly only have had a brief flirtation with) is that the probes are clip on, whereas the EDAC cuvettes need cutting into the circuit. This obviously eradicates disposable costs and permits addition of the device whenever whimsy dictates.
One novel adjunct to standard perfusion hardware which the guys at GOSH were particularly enthusiastic about was a bar code scanner which plugged into the USB port on their data management system. This device which was purchased off the shelf in an office supply outlet, once plugged in, would recognise all the bar codes on perfusion products, blood products and patient labels- thus eradicating the need to tediously manually enter all the lot numbers.
The team at GOSH are just about fully staffed for their current workload, following a lengthy period of being understaffed. For this reason they have not been overly active in the research field of late. This is something they are hoping to rectify over the coming year.
GOSH, if you are not aware, is slap bang in the middle of the city. Due to its location it is particularly challenging (financially speaking) for those that work at the hospital to live close by. The majority of the perfusion team live around one hour away from the hospital. As is often the case much emergency work takes place after hours. For this reason they are about to embark upon a trial of the on-call perfusionist (who starts a little later in the day) actually staying in the hospital overnight. In recompense for this that person would then get an additional day off. What I am not sure of is if they are renumerated for the night whilst in hospital.
Whilst at the hospital they had three patients on ECMO in the CICU. One patient had swine flu, one RSV+ bronchiolitis and one post-operative cardiac patient. At GOSH the perfusionists are present for ECMO initiation, cessation and trouble shooting. Besides this they have little involvement in the day to day running of the ECMO or indeed the nursing education. This is a situation which came about due to low perfusion staffing levels and one which is regretted to some extent. I can certainly empathise with this situation. I personally believe that, although cardiac theatre may be our bread and butter, keeping an active role in perfusion related duties such as ECMO, cell salvage, point of care haematological monitoring, research etc is vital to the longevity of our profession.
Having transferred patients on ECMO around our hospital one ongoing issue is the fitting into the elevator with all associated equipment and manpower. Due to GOSH having a newly built cardiac complex they also paid careful attention to the choosing of an elevator to transport their patients from the theatre up to the CICU and beyond (although I do not believe it extended all the way to heaven).
The elevator they choose not only had a power outlet; it was also the largest elevator available in Europe. It was really quite something- I truthfully maintain that a Mini Cooper (one of the new ones) could either drive straight in or be parked sideways in the elevator. Over all I really enjoyed my week at GOSH. They have a good team and do some very good work. It is also always refreshing to go and visit other units to see that there really are many ways to skin a cat, and I am certain we can all take some useful, and some not so useful attributes from other centres. But what is important is that we are open to new ideas and continually challenge what we believe to be true.
