Sunday, February 28, 2010

Shaun White: From Open Heart Surgery to Olympic Hero

I'm reposting a recent news article which I think is relevant to our industry, not only because it's about Heart Surgery and a famous person, Olympic Gold Medal winner, Shaun White... but because that makes me think of all the people in perfusion who make a difference every day. What makes Shaun White excel in his field are the very same things that are common among excellent perfusionists who assist in open heart surgeries every day... It's commitment and passion. Shaun White practices his sport every day with commitment. He falls down, he gets up and tries again. The desire for perfection is a passion. In our profession, perfection is a passion as well.

I found this article inspiring.... and thought you might, too.



Shaun White: From Open Heart Surgery to Olympic Hero
Posted at Globalgrind.com

When you are born with congenital heart failure the odds are stacked against you. No one would expect you to be a superstar athlete, and any thoughts of being an Olympic winner are dismal. Yet, snow boarder Shaun White has proven that he can be that and more.

White was born with a congenital heart defect called tetralogy of fallot, in which the heart has four abnormalities. Within his first year of life White had undergone two open heart surgeries. It was a mere five years later that he stepped foot on a snow board and found his calling. From ages 6 to 12 White racked up snow and skate boarding trophies all over California, eventually going pro at the age of 13. Not only is White the first two time Olympic gold medalist in his sport he was also the first person to compete in the 2003 Summer and Winter X games.

It seems that for Shaun, his heart condition as a child hasn’t stood in the way of something he was destined to do. In actuality it’s just a tiny part of what makes him the success he is today.

After wining his second gold White was interviewed by Oprah and said of his accomplishments:

“It brings me back to all the kinds of strange times, because when my parents first got introduced to snow boarding and I started snow boarding there were no Olympics, no X games, no money or anything in the sport, they just basically knew I had a talent and went for it.” White goes on to say “I had some heart conditions when I was first born so going from that struggle to now letting me go out there and do all these things...you put a dream in front of somebody and your so young and it just seems so close and I said I can do this and I just took every step towards it.”

Beyond his heart defect what Shaun White has is tenacity, “I’ve just always had this fight since I can’t even remember,” said White in an interview with 60 Minutes. If there is anything fans can learn from White is that passion and commitment fuel your dreams. Despite any road blocks on your path to success there are tools that motivate you as a person to make goals for yourself and reach them. Shaun White shows commitment and dedication for his sport but most of all he shows his great love for it. Who else owns their own half pipe so that they can continuously practice and come up with new tricks- Shaun White does, thats who.

For someone with such great accolades, White is humble and there is reason to believe some of that humbleness comes from the fact that he knows how lucky he is. White may have been born with a heat defect but even more he was born with the talent that has over shadowed his health condition. This flying tomato will surely continue to make himself a house hold name, all while following his dreams.

Tuesday, February 9, 2010

Historical Perspective On Perfusion - News Story Reprinted

Open heart patient looks back

Toledoan underwent surgery in 1959


By JULIE M. McKINNON BLADE STAFF WRITER
Link to Story

Sandra Katschke has had a heart murmur for more than 50 years.

Still, that defect is far better than the likely alternative for the 62-year-old Toledoan, the first locally to have open heart surgery using a heart-lung machine.

Without the November, 1959, surgery purportedly to widen her pulmonary valve, the then-12-year-old Sandra Schermbeck probably would never marry and have children, one of her doctors said.

"He told me I wouldn't live to be 21," Mrs. Katschke recalled. "I'm doing really well."

At age 12.At age 16 with Mother.



Dr. Michael Moront, a Toledo cardiac surgeon who met Mrs. Katschke last week after learning of her story, said she probably needed the area above the valve widened, not the valve itself, because it wouldn't have lasted this long if it was congenitally defective. Dr. Moront listened to Mrs. Katschke's heart last week and noted the murmur, and he termed the grandmother's longevity, especially without further surgery, "miraculous."

"Today, most people would say you would require more surgeries," Dr. Moront said. "They did a remarkable job for you."

Much has changed in cardiac surgery since Mrs. Katschke was operated on at Toledo Hospital by a team of 14, including several doctors. A couple dozen more doctors observed the novel surgery, for which a heart-lung machine was used to mechanically circulate and oxygenate blood so work could be done on her heart.

"It was very exciting stuff back in the '50s, and it still is today," Dr. Moront said while showing Mrs. Katschke and her husband of 40 years, Ed Katschke, a heart-lung machine currently used at Toledo Hospital.

Heart-lung machines, first successfully used in Philadelphia in 1953, are one aspect of cardiac surgery that has changed since the specialty was in its infancy and Mrs. Katschke underwent surgery.

Before heart-lung machines, some surgeries were performed by connecting a child to a parent, who kept blood flowing, Dr. Moront said. "The adult would serve as a heart-lung machine for a child," he said.

Oxygenating blood was the trickiest function with heart-lung machines in those days, and improvements have been made through the decades, said former perfusionist Terry Kirch of Northwood, who started working at Toledo Hospital in 1968. A perfusionist is a medical technician responsible for blood transfusion and the heart-lung machine during cardiopulmonary surgery.

Originally, patients could be on heart-lung machines for only minutes; now they can be on for days, Mr. Kirch said. Plus, heart-lung machines were primed with donated blood until the early 1970s, when a solution started to be used, he said.

"That, I think, is one of the biggest advances we had," said Mr. Kirch, who was one of the first 75 people nationwide certified as perfusionists.

Mrs. Katschke's grandparents, the late Marie and Warren Lincoln, who were her guardians, had to locate 30 volunteers to donate A-positive blood for her surgery. Volunteers included seven inmates from the county jail.

Preparing the heart-lung machine and donated blood for Mrs. Katschke's surgery probably took several hours, said Kevin Fleming, a Toledo Hospital perfusionist who explained last week to the Katschkes how the machine works.

"Back then, it would take about as long to prepare the case as it did to do the case," he said.
Mrs. Katschke, who prior to surgery was often sick, missed a lot of school, and was unable to play, returned to school after holiday break.

She remembers being afraid of surgery.

"There was one little boy who passed away before my surgery, and I was scared to death," she said of a fellow patient with a different heart problem.

An intensive-care unit to closely monitor patients was not used when Mrs. Katschke had surgery. Some medications used then still are around today, including epinephrine, but there have been many pharmaceutical advances since, Dr. Moront said.

There also have been a slew of advances in surgical techniques and equipment, he said. Three-dimensional ultrasounds, for example, give surgeons exact images.

Although Mrs. Katschke has had other health problems since her 1959 open heart surgery, she has not had cardiac issues.

The mother of three doesn't take heart medication either, although she does tire easily and regularly sees a cardiologist, she said.

"I still have trouble if I'm walking a long distance," Mrs. Katschke said. "I get out of breath. Other than that, I do fine."

Contact Julie M. McKinnon at: jmckinnon@theblade.com or 419-724-6087.

Tuesday, February 2, 2010

Meeting Notes from Society for the Advancement of Blood Management (SABM) Conference 209

The following report is a summary of reflections from the SABM 2009 Conference held in November. Many thanks to Anton Johnson, CCP, for preparing this and allowing us to share the information here.

SABM 2009
Latin American
Blood Management Conference

Attending the Society for the Advancement of Blood Management meeting in Cancun, Mexico, was an opportunity to gain current perspectives on techniques in allogenic blood conservation, if not elimination.

A diverse schedule was on tap and, refreshing was the review of current literature and reiteration of well established methodology.

If allogenic blood use is to be scrutinized, the goal should not be reduction of use but total elimination. The religious conviction of the Jehovah’s Witness may be the best philosophy to adopt in the best interest of every patient. The approach, or belief, that any use of allogenic products constitutes failure can easily be adopted and, seeing that it has been implemented elsewhere, can be attained with reasonable effort.

Working at a facility where autologous cell saver product is often discarded, the belief of the surgeons is that it contains heparin and thus is responsible for post protamine bleeding, only to use allogenic products, this meeting was very refreshing. The environment in which we practice can often result in ‘dumbing down’ in our approach; we must continue to practice in support of the surgeons who dictate our patient care. Thus, this meeting was invigorating in reaffirming practices that have been proven nationwide.

The key phrases being presented included adjectives including ‘peer reviewed’ and ‘evidence based’, along with ‘double blinded’; these seem to cover a vast array of scientific papers whose conclusions serve to shape and drive practices whose ultimate goal is the elimination of allogenic blood use.

While I will contend that I am not a physician; listening to anesthesiologists who report practicing guidelines, that reduce transfusions until the mixed venous saturations fall below 55%, provided significant food for thought coming from a practice where we transfuse at saturations below 70%!

Several approaches warrant closer observation; the use of erythropoietin to stimulate the bone marrow to produce red blood cells and thus raise the preoperative hematocrit has merit. Folic acid, iron supplements and Vitamin B-12 have been successful in the management of patient’s hematocrit who may have presented in anemic conditions.

Reducing all blood draws preoperatively, in addition to reducing the volume of these samples has been encouraged. Reports that the volume of these samples have not changed in years, while the testing devices have continued to reduce their required volumes, leads one to think that further change is necessary. Englewood Hospital, New Jersey, has gone completely to pediatric tubes in this regard; they reported a several 100mls reduction in just laboratory specimens and consequent gains in patient’s hematocrit.

Preoperative blood management requires a multi-disciplinary approach to create an infrastructure that provides evidence-based actions. Actions are the alternative transfusion pathways that have been proactively configured to maximize clinical and cost benefits.
Each unit of blood, allogenic or autologous, transfused or collected, has an impact on either the patients’ outcome or the costs to provide appropriate care.

In-depth clinical and costs/benefits analysis is required to assure accurate and effective outcomes.

Establishing an effective Transfusion Committee is essential to implementing transfusion practices. This committee should be lead by an opinion leader and contain a multi-disciplinary membership covering; physicians, nurses, blood bank staff, perfusionists, risk managers, representatives from Information technology and Quality Managers.

Their goals should be;

1) Educate
2) Improvement Strategies
3) Collect Metrics

Sobering statistics were presented;

Price Waterhouse reported $210 billion in defensive medical tests which included redundant, inappropriate or unnecessary tests.

The US ranks 15th out of 19 industrial nations in quality of care of their patients, although we spend twice as much per patient in care rendered.

100, 000 patients per year die in hospitals for reasons other than their admission diagnosis.

Platelet Gel reimbursements were a small issue, several practitioners reported on billing strategies that boarded on the unethical. While no specific coding exists for platelet gel, methods of procuring positive billing results included using codes for blood draws and analysis. I suspect that this will not last for long, nor will they be encouraged by institutions.

On another note; the practice of using 3L bags of saline for cell salvaging during the wash phase was considered. These bags are indicated by the manufacturer for irrigation only, not intravenous use! I thought it overly ambitious that this practice was endorsed. It would seem that substituting an ‘irrigation only’ substrate in place of an easily obtained intravenous product, benefits the user only. Any patient benefit is not being considered. This practice should be brought to the attention of the institution’s risk manager for further review. Personally, I feel like it is a flawed approach and will not support its practice.

In closing; thank you for allowing me to attend this refreshing meeting devoted solely to the conservation of blood products. Other meetings try to cover too much material, even while pertinent, and current ‘hot’ topics are left in supporting roles. I look forward to practicing the principles gained from this attendance.

Monday, February 1, 2010

The Heartbeat

Trident Health Resources, Inc.'s February edition of The Heartbeat was released today. For this month's issue, click HERE

Looking for earlier month's issues? Visit Trident's home page HERE for the archive of previous month's newsletters.