Live Blog: ANZCP Down Under [2]

Media Journalism by…

Martin Gill: Perfusionist

(Children’s Hospital at Westmead, Sydney Australia)

Editor’s Note: This opportunity is provided by the efforts of, Mr. Martin Gill, perfusionist, who is attending this meeting in Sydney.

The intention here @ CircuitSurfers is to offer up a library of these types of objective POV’s (Points of View) to highlight conferences as well as “personalize” what a potential attendee can expect if deciding to participate.

ANZP Conference: Day 1

Today was the beginning of the more formal component of the scientific meeting, with the first session focussing on transfusion morbidity and blood conservation. As I am sure you can imagine much thought provoking information was presented.

The session opened with the key note speaker, Mr Gavin Murphy from the UK. Gavin is both a consultant cardiac surgeon and avid researcher.

His talk centered around current available literature on blood management and it’s ability/ inability to demonstrate whether transfusion is associated with adverse outcome or causes adverse outcomes. He reviewed many perfusion strategies including autologous pre- donation, normovolaemic haemodilution and cell salvage. It would appear that current literature would deem cell salvage as being associated with the least risk.

Whichever intervention is used this strategy must be focused on the patient need. Of particular interest to me is study yet to be finished / published that aims to discover whether NIRS can be used to guide transfusion.

Next up was Prof Isbister from here in Sydney. This was a very thought provoking talk highlighting the difference between what’s best for blood supply and what’s best for the patient. The Prof remains mystified after many years in the ‘blood field’ as to why RCT’s focuss on safety and not efficacy, an approach which is reversed in other areas of medicine. It would appear clear that the hazards of transfusion are definite, probable, or possible.

Darryl Mcmilan rounded off the session by extolling the virtues of the perfusionist as being a vital cog in the wheel as part of a collaborative approach to a patient management plan for blood management. Point of care tests are viewed by Darryl as vital in blood conservation for a patients transition from CPB to post op care.

Quick break before session 2.

=
Cheers
Martin

Session 2

Well quick whizz around the trade displays and a cup of tea then back to session 2.

This session focus is on transfusion morbidity and blood conservation.

Gavin (the key note) commenced the session by discussing risk modification for post cardiac surgery lung injury. Current literature is reported to point towards lung injury being an extremely common occurrence post CPB with a direct link to mortality, morbidity and (of interest to those holding the purse strings) cost. Gavin believes that the best way to currently ameliorate this lung injury is to restrict transfusion.

Other methods are (a huge surprise to me) epidural anesthesia. Apparently epidural switches off components of the CNS which assist in the reduction of inflammation. What does the future hold?

In Gavin’s opinion the future is definitely in the hands of pharmacology. It is understood that inflammation reducing agents are the focus of intensive work and that soon these will be the main stay of pulmonary protection for patients undergoing CPB.

Free papers made up the rest of the session. At this stage I think it is worth saying that perfusionists are amazingly adept at carrying out good quality research with, at times, limited resources. We heard about the link of oxidative stress to blood product exposure- surprisingly no difference was found with the age of the red cells. We then were presented with data pertaining to normovolaemic haemodilution in cardiac surgery- this work speculated that the patients that may be best placed to donate blood are the ones that would probably not need the transfusion.

Next was a review of blood product usage for 10000 CPB patients- 14 % receiving blood products of one type or another. The speaker speculated that safety in perfusion practice, through protocols, is the key to practice in blood products and perfusion in general.

A bit of fun for the last session with an audience participation response system. This threw up a few novel answers. We apparently had an audience predominantly with more than 10 years perfusion experience. 59% believed that current evidence points in one direction for blood transfusion. 13% do not use a cell saver on CPB.

Only half the Perfusionists do provide point of care haemostasis management to patients. 13 of the audience do RAP there patients. 42% of the audience have a written protocol for red cell transfusion on CPB. 52% accept 22% as the lowest on CPB Hct.

Well that must be lunch.
Martin.

Session 3

Great lunch- they even sorted out gluten free for the celiacs amongst us (that means I will get through this afternoons sessions without visiting the bathroom every 5 mins).

Session 3 for the day is focussing on collaborative day registries. The first part of this session focused upon making the transmission from measurement to improvement.

The concept was presented that participating in a collaborative data group enables the facilitation of knowledge diffusion. The importance of data collection was echoed by David Marshman, a surgeon from Sydney.

He felt that the collection of data is essential due to the requirement of needing to know where you currently are in order to establish where you want to go. The session wrapped with an informative presentation on the evolution of the International Consortium of Evidence Based Perfusion.

Data collection can often be a quite a dry dish. This session, however, left no doubt about the relevance and importance of its collection and utilization.

Sent from my iPad

Session 4

Well, the fourth and final session of the day. And what away to finish the day- chaos theory, ethics and evidence based medicine.

This session consisted of a/ prof Ian Kerridge and Tom Gratton Smith. Could there really be an alternative to evidence based medicine. Maybe. It would appear that one can never ignore the clinical situation in front of ones self. A very interesting point of view was raised by Kerridge- the fact that an RCT is required must lead to harm being done. Are RCT ‘s always required when evidence may exist from cohort studies previously carried out? (CEASER was the example alluded to) hmmmm.

The value of current medical journals was touched upon. A very interesting slide was shown with quotes from editors and past editors of BMJ, NEJM etc all casting doubt on the value of current literature due to the tainting of industry on current studies.

WOW what a session.

Right, tonight’s dinner is on Fort Denison – a small island in the middle of Sydney Harbor- its a hard life!!!!!

See you in the morning.
Martin.
Sent from my iPad

On the ferry to the Friday dinner, and the dinner venue.