Well today for my second full case on bypass I was entrusted with a heart transplant. The case was extremely busy. Thanks to my two other perfusionists we were able to handle it. SO much different from any other case. First we primed with FFP which was really weird to see in the pump (its yellow). Then the bad heart is removed there is no cross-clamp time, they keep track of ischemic time instead. The new heart is then placed in the chest and attached. We had a volume issue the entire time for most of the case we had less than 400mL in the reservior. It was one of the most intense things I have ever been a part of. Our ischemic time was 88 min. and total bypass time was about 120 minutes. Unfortunately we were dealing with such a volume issue we ended up giving a lot more blood products than we wanted to but, it worked. Last update at 5:30 patient was doing well in ICU.
The light bulb moments:
1. The target blood flow is just a "suggestion" you can accomplish good results without flowing at the target. When the venous return was AWFUL, we were able to adjust to it based on our flow.
2. There are a number of things I can do on the pump to get the same result. You can increase your arterial pressure with more than just drugs, use your flow, only if you have enough volume to accomidate that. Your pH can be corrected or changed based on your CO2 content and not just with your bicarb.
3. I have so much to improve on. I see all the stuff that the 3 of us accomplished and wondered how I was ever going to be good enough to be able to do it all by myself. (NO electronic charting). Between running back and for for FFP and units of blood, we still had to keep up with our charting.
Overall an experience I will never forget! I have seen how fun and exciting perfusion can be. We had a fantastic surgeon. He was very understanding (he had about 6 people scrubbed in at the table).
-Gregory Kitchen
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