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Perfusion NewswireMain ZoneResults & Discussion From the 2008 Cerebral Oximetry Survey

Results & Discussion From the 2008 Cerebral Oximetry Survey

Main Zone, Mobile Zone, Perfusion Zone

Introduction:


Cerebral oxygen saturation monitoring has gained significant traction in cardiac surgery over the last ten years.  At many institutions, cerebral oximetry is now considered “standard of practice” and is employed on every open heart procedure.  This survey was conducted in order to assess the status of cerebral oximetry in the United States.  Specifically, we wanted to develop clear understanding of the perfusionist’s role in cerebral oximetry monitoring and determine whether or not cerebral oxygen saturation monitoring changes the way perfusionist’s practice.


Methods:


A twenty question survey was prepared using the Perfusion.com online survey application.  Input on the survey questions was sought from individuals who have extensive experience with cerebral oximetry and from the two manufacturers of cerebral oximetry hardware (Somanetics and CAS Medical Systems).  This survey was posted on the Perfusion.com website, and invitations to participate were sent out via electronic mail on the Perfmail list server.  Login to the Perfusion.com website was required prior to accessing the survey.  This authentication method allowed us to limit each individual to one survey response, eliminating the possibility of duplicate submissions.


Results:


Ninety five total responses to the cerebral oximetry survey were received.  Of these response, five were incomplete and were deleted from the final results.  As such, we were left with ninety complete survey responses. The survey questions and their respective answer summaries are detailed in the figures below.

















































































1. All pedi heart procedures
2. All major vascular and orthopedic surgeries
3. PTE
4. Patients with Carotid disease or prior endarectomies
5. Circulatory Arrest
6. high risk procedures, elderly, carotid stenosis, diabetics, redo surgery
7. All adult cardiac
8. pediatric surgery only <10% of total case load
9. every case










1. unsure
2. not sure what you are asking




It should be noted that the CasMed FORE-SIGHT device has only been on the market for approximately two years, while the Somanetics device has been commercially available since approximately 1998.





Of those individuals that use cerebral oximetry, the following results were reported:






Of those individuals that use cerebral oximetry, the following results were reported:

















1. Circulating nurse
2. Nurses in holding room
3. Can’t calibrate a trending device



No additional answers were reported despite the indication.




Note: These items are ranked in order of action, so the lowest value it the first course of action and the highest value is the last course of action.





Of those individuals that use cerebral oximetry, the following cost for each sensor was reported:



















































































































































































































































































1. No Comments

DCH Regional Medical Center
Tuscaloosa, Alabama
2. No comments
3. Good data – cerebral oximetry is excellent perfusion tool.
4. Its a trending device so the numbers mean absolutely nothing.
What it really does is make the team especially Anesthesia & Perfusion pay better attention to the patient during surgery.
5. I believe that cerebral oximetry is a valuable trending tool to monitor adequate perfusion to the patient. It alerts the perfusionist to the fact (in most cases) that there is a physiologic change happening that needs to be attended to. I feel more comfortable pumping a case with it on the patient.
UMASS Memorial Health Care
Worcester, MA.
6. Rush-Copley Medical Center, Aurora, IL
7. I was unsure of the answers to Questions 6 & 19 .
8. None
9. not sure about the price
10. Methodist Children’s Hospital
11. Cerebral Oximetry has been the only technological advance in perfusion over the last 7 years which has directly changed the way I practice perfusion. I would not consider doing a procedure without it.
12. San Francisco Bay Area Hospitals
13. We have found the Foresight signal to be much more precise than the “trending” values we saw on any model of the Somanetics system, giving us greater confidence in making decisions regarding our intervention protocols. As far as workflow improvement, being able to place sensors at anytime, and not having to get a baseline really makes a difference in getting the patient prepped.
14. None
15. Providence Hospital
16. St Joseph Hospital
17. I wouldn’t do a case without it.
18. – Some of the priority of some interventions depend on the current flow rate, sweep rate, FiO2, MAP, Hct, temp, at the time of 20% decrease.
– Ironically, I have experienced a decrease in SrO2 readings with decreasing temp.
– Cerebral oximetry would be used on 100% of cardiac cases if Perfusion was responsible for set-up, application, and calibration of pads & monitor compared to Anesthesia.
– Perfusion charts data, but anesthesia does not
– Internal recording of data onto disk or SD card is not utilized, so data is not graphed after the case.
19. We do not your cerebral oximetry.
20. Question 17 will vary depending on what is happening. i.e. unless we lose a reading there is no reason to check the sensors. We also chart everything while making the changes. Kent General
21. Phoenix, AZ
22. The list for priority of intervention is contingent on the complete clinical picture. The co linearity of the variables, compounded by the complexity of clinical setting makes the survey question useless as it is posed.
23. I wish we did use cerebral oximetry at this hospital. I have had the rep from Somanetics here to do a presentation, but the anesthesiologist still think it’s the same as a BIS & influence the surgeon that it’s unnecessary. Question 17 requires me to enter data so it what I would do if we were operating it.
24. Question 17 should be re-written.
25. Memorial Hospital Chattanooga, TN
26. St Alphonsus RMC
27. Question 17 does not have absolute answers or order of interventions. The interventions used and their order are dependent on the type of surgery, point of time during the procedure and the rate of saturation drop. There are to many variables to have a set checklist for every situation. Experience is the biggest factor in utilizing this technology.
28. Kaweah delta CA
Julian Williams CCP
29. I am interested in all information to support the use and experience with cerebral oximetry. We currently don’t use co but would like to.
30. Bryan, your survey does not allow for accurate answers. Since we did eval both of the listed devices but anesthesia chose to not use either, we do not use cerebral oxy on our adult cases. But your survey does not allow for this line of answers.
31. I have been attempting to have anesthesia use our cerebral oximetry device for hart surgery cases, but have, as yet, been unsuccessful.
32. None
33. None
34. Will you reveal results???
Thanks
PA
35. This device has shown that better outcomes can be achieved by having patient specific information on cerebral blood flow. Treatment is patient specific as there is not one formula for all. Harbor UCLA Medical Center
36. contract- hospitals confidential
37. Question 19 – We use Cerebral Oximetry, however, I do not know what the price of the sensors are, so I entered 10.
Charting of the Cerebral Oximeter numbers is personnel dependent. I prefer to chart them with my other chart data, my fellow perfusionists do not.
38. Good to know if anyone is expanding the use of this technology. I see a lot off value in the monitoring-Russell Brown, St Vincent & St. Lukes Hospital’s, Toledo OH
39. None
40. None
41. Hays Medical Center
42. Re: question 19. I do not know what the hospital pays for the sensors.
43. We have a Somanetics machine. It is administered by Anesthesia. It is not used routinely at all. Probably less than 1-2% of the time. There is no protocol for it’s use. It is here from a former study. I answered question #17 in light of what we (perfusion) would do if and when it were to be used. There is , however I am increasing interest for it’s use. I would like a copy of the results of this survey. Sincerely, Russell Butler, CCP
44. St. Francis Heart Hospital, Indianapolis, IN
45. I don’t know how much the sensors cost since anesthesia provides that service.
46. None
47. Eastern NC
48. None
49. not responsible for purchase, placement, charting
50. Mission Hospital Regional Medical Center
Mission Viejo, CA
51. Q17 Has no N/A for non-users … so I entered as if we used the device.
52. MMMC
53. Sutter
54. not good science why are we waiting time and energy on this device
55. Nicole M. Michaud
St. Vincent Hospital
56. St. Vincent HHC.
The one thing that has changed with using the COM is that giving blood is a option that is used earlier. Is this a good thing or bad? My concern is that this is a monitoring modality that can make money; not that it has changed our outcomes to a great degree.
57. INVOS has verified that what we do is appropriate, i.e., we always use 1.5% forane on all patients. After hundreds of patients (1500/yr) experience w INVOS, we found that there was little adjustments or added info from it so we only use it ~15%.
58. None
59. CFVHS
60. How and when the value changed determines the order of response.
61. Multiple
62. Number 17 is a bad question
63. None
64. Lutheran Hospital
65. Please throw out answers to #17…we don’t use it, so the right answer is n/a which the survey won’t accept.

Tripler Army Medical Center
66. None
67. St. Joes Bellingham, WA. Two anesthesiologists use only one sensor on the right side.
68. should be state of art for ped and adult cardiac surgery
69. mainly used on carotid surgery
70. The modality is to increase temperature as one of the parameters not decrease it as to decreasing temperature will decrease your cerebral sats in some patients due to shunting of the brain.
71. The intervention sequence has a lot of variables involved that may or may not be simultaneous. I think you have too many acceptable ideas and sequence of reporting that drop depending on which institution you are working at.
72. Question # 17 has factors that affect the answers, i.e., age, type of procedure, venous cannulae utilized. My response to #17 could change depending on those issues at hand.

Great survey. Keep up the good work.
73. I see my perfusion techniques change with the use of the cerebral oximetry. We document everything especially if we need to add blood products. This has been very instrumental with our Blood Utilization Review Board.

Not sure what you were asking on #6.

Nice Survey, Brian. I would be very interested in the results as well. Susan Englert.
74. Missouri Baptist Medical Center, St. Louis, MO
75. “Guestimate” on cost.
76. None
77. None
78. Too expensive for adult patients
79. None
80. There truly is no way to know whether the “impending situation” would have had any effect on clinical outcome had it not been identified. we were unable to demonstrate any clinically significant change in outcomes at our institution during a trial period with adult patients. we use it in pediatric procedures at the request of the surgeon.
81. Not sure how reliable the data really is. You can manipulate the data any way you wish – run CO2 levels higher, flows higher, HCT higher and normothermic temp. If ABG’s, SVO2, flows, MAP, venous drainage and urine output are adequate, the “random number generator”, i.e. the Somanetics opens the door to liability for the perfusionist. A number of times, the Somanetics will display 25-40% below baseline without any ill effects post-op. And yet it will display higher than baseline an entire case, and the patient never wakes up – explain that.
82. N/A
83. omit number 17, there is no order. I don’t know the answer to 19.
84. None
85. it’s a good addition of information to the team
86. St Mary’s Hospital
87. None
88. Will be starting a trial soon. I believe Cerebral Oximetry should be the standard of care for cardiac surgery.
89. Currently we conducting a study to compare our outcomes with both the CASMED and Somanetics devices.

Ken Jeleniowski, CCP
Chief Perfusionist
Hartford Hospital
90. I’ve used both the Somanetics and the Casmed devices. The foresight is a superior device. It doesn’t require a base line so for those emergencies from the Cath Lab that are already intubated it’s really nice. Also the Casmed’s numbers appear to correlate to interventions more appropriately. We have switched completely to the Casmed.

Conclusions:

It is clear from the reported results that cerebral oximetry use is gaining favor as a standard monitoring practice in cardiac surgery.  At most institutions where cerebral oximetry is used, perfusionists are playing a critical role in the monitoring and charting of the cerebral oximetry data.  The results also indicate that perfusionists are modifying their techniques based on the cerebral oximeter.  Perhaps most profoundly, the results of this survey indicate that the use of cerebral oximetry has often alerted the surgical team to an impending situation that may have otherwise gone undetected, possibly leading to an adverse outcome. Since air embolism in cardiac surgery will be no longer be reimbursed by Medicare, cerebral oximetry can be a valuable tool in the early detection and treatment of a possible embolic event.

The STS has expanded its database to including cerebral oximetry data, and this will surely play a critical role in expanded adoption as more concrete data emerges.  Off label uses of the cerebral oximeter are also increasing as creative cardiac teams find new uses for the technology.  The manufacturers are sure to embrace new indications for use and seek expanded labeling for their devices over time.

Since this is was the first survey we have conducted on cerebral oximetry, trending information is impossible to calculate.  This survey will be repeated and likely expanded over time, so that we can accurately monitor the trends with this technology.  We appreciate the participation of the perfusion community in helping design and complete this first survey on cerebral oximetry.

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