Perfusion is the circulation of blood to organs and tissues in the body, which provides them oxygen and other nutrients essential for function. In cardiac surgeries, a machine performs perfusion for a person’s body while his or her heart is being operated on — and a perfusionist is the clinician responsible for running the machine. In some cases, perfusionists must use aggressive blood management techniques to address the needs of the patient, especially pediatric patients. We interviewed Bharat Dhatt, MD, director of perfusion at Children’s Hospital of New Orleans, to find out more about innovations in perfusion and the journey toward making bloodless perfusion more common.
Perfusion Innovations in Pediatric Surgery
Because patients are smaller and operations may necessitate greater delicacy, pediatric surgery can be a prime area for innovation in the OR. Dr. Dhatt explained that modifications must be made to perfusion services to fit the needs of the child.
“[A] two-kilo baby has probably a blood volume of 180 CCs. So you can’t really connect a pump, which needs a 500 CCs of volume, because then you got to hemo-dilute him,” says Dr. Dhatt. “And so there’s a balance between oxygen-carrying capacity and also trying to conserve blood transfusion.”
Research shows that an overuse of blood transfusions can actually increase the possible risk of morbidity in adult patients. Learning to manage perfusion with a lower blood volume paves the way for better outcomes in the future, both for children and adults. Bloodless perfusion innovations have also been developed and studied in response to the needs of patients who are Jehovah’s Witnesses.
In the course of his work, Dr. Dhatt has worked with others to optimize perfusion services for lower usage of transfused blood, meeting the needs of pediatric patients and creating opportunities for more successful surgeries.
“…we went from a traditional horizontal pump to a vertical pump. … So almost every pump is as close to the heart as the arterial pump. So that’s the first major change we made,” he says. “And then we changed the circuits because of that, we changed the circuits, we changed the size… it’s all about planning and configuring the right miniaturized circuit. … In New Orleans, we had about 400 CCs of prime volume, and we’re down to 124 for our littlest neonates.”
The Journey Toward Bloodless Perfusion
Bloodless perfusion is possible but still an emerging process. Autologous blood transfusion, where the patient’s own blood is given back to him or her, is also becoming more common. Dr. Dhatt’s team has made significant strides toward bloodless perfusion because of the techniques they’ve been using.
“We have not done a bloodless perfusion yet. It’s a journey. It’s a culture you need to build,” says Dr. Dhatt. “But what we have done is instead of needing a unit of blood to transfuse to fill the pump, we just need a partial unit.”
SpecialtyCare Champions Innovations in the OR
As patient needs and medical technology evolves, the OR is obligated to evolve as well. At SpecialtyCare, we champion innovations in the OR that make surgery safer. We partner with health systems to improve outcomes by providing services such as autotransfusion, sterile processing consulting, surgical assist, and minimally invasive surgical support, and we are the industry leader in perfusion and IONM. If you would like to work with us, whether you’re an independent medical professional or you represent a hospital, contact our team today to learn more.