Clinical Perfusionists Research Articles

Evaluation of university and training standards in clinical perfusion, an European-wide survey.

Adequate theoretical and practical training of prospective clinical perfusionists is essential for maintaining clinical standards and ensuring patient safety during cardiac surgery procedures. Perfusion schools play a crucial role in establishing and maintaining higher education and training standards in clinical perfusion. The aim of this study is to obtain a comprehensive overview of European training standards in clinical perfusion in 2023. For this study, 53 perfusion schools in Europe were found and contacted, of which 30 (56.6%) responded, giving a sample size of n = 30, which were then included in the data analysis. The quantitative data of the survey are analysed using descriptive methods. The university and training standards in clinical perfusion in Europe vary in many respects. Starting with the entry criterion for studies (most frequently a required bachelor's degree 36.7% or 2nd most common an university entrance qualification 30%), the duration [from <12 months (13.3%) up to 36 months (13.3%)] and regarding the content of the teaching in clinical perfusion [<30 European Credit Transfer System (ECTS) (33.3%) and more than 180 ECTS (6.7%)]. The mean value for teaching in clinical perfusion content is 62.63 ECTS credits. The obtained results show important differences between countries and schools. As such, they form a valuable database for future discussions establishing a common European curriculum and training standards for perfusionists. For the generalizability of the results, further evaluations and larger samples are needed.

Mastering the Best Practices: A Comprehensive Look at the European Guidelines for Cardiopulmonary Bypass in Adult Cardiac Surgery.

The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.

Student Breakout Session

The 2022 students-only session is a unique opportunity for perfusionists-in-training to connect with one another and to create a space in which they feel confident to speak up. The session will comprise three parts. First, there will be an introduction to the structure and function of the Australian and New Zealand College of Perfusionists (ANZCP), including the roles of the Executive and Board, requirements for recertification, opportunities to participate in the College, and the invaluable resource that Perfusion Incident Reporting System (PIRS) is. The presentation will then cover preparation for the Certification Exam VIVA. Expectations for this exam will be clearly explained, effective study techniques will be explored, and the group will step through a practice question together integrating the strategies discussed. The final topic of the session will be “life beyond traineeship” focusing on how to continue acquiring skills once formal training is complete. Students will be encouraged to see attaining a Certified Clinical Perfusionist (CCP) as the beginning of a lifelong learning pathway and the group will discuss how to identify gaps in their perfusion experience and work on strategies to fill them, to become a confident and well-rounded clinician.

Crisis Scenarios for Simulation-Based Nontechnical Skills Training for Cardiac Surgery Teams: A National Survey Among Cardiac Anesthesiologists, Cardiac Surgeons, Clinical Perfusionists, and Cardiac Operating Room Nurses.

Nontechnical skills in cardiac surgery are vital in ensuring patient safety in the operating room (OR). To train these skills in a simulation-based scenario, a collection of commonly accepted crisis scenarios is needed to serve as a framework for a simulation-based training program. The objective of this study was to identify and reach consensus on a collection of relevant crisis scenarios in cardiac surgery suitable for simulation-based team training focusing on nontechnical skills. Using the Delphi method, a national assessment was performed among cardiac surgeons, cardiac anesthesiologists, clinical perfusionists, and cardiac OR nurses in the Netherlands. In the first Delphi round, potential crisis scenarios for simulation-based team training in cardiac surgery were identified. In the second round, the identified scenarios were rated using a 5-point Likert scale. Finally, based on consensus (two-thirds majority), scenarios were prioritized and explored for feasibility. One hundred fourteen experts participated in the study (26 cardiac anesthesiologists, 24 cardiac surgeons, 25 clinical perfusionists, and 39 OR nurses), representing all 16 cardiac surgical centers in the Netherlands. In the first round, 237 scenarios were identified. After eliminating duplicates and grouping similar scenarios, 44 scenarios were scored in round 2, which finally resulted in 13 relevant crisis scenarios with an expert consensus higher than 67%. Thirteen crisis scenarios relevant to simulation-based team training were identified by an expert panel consisting of all members of the cardiac surgical team. Further research is needed to evaluate the educational value of the respective scenarios.

Perfusionist removal of intra-aortic balloon pump catheters improves efficiency without an increase in complication rates.

The intra-aortic balloon pump (IABP) is one of the most utilized cardiac assist devices. Patients receiving IABP therapy are typically managed in high acuity clinical care areas with limited bed space and high demand. Our center instituted a certified clinical perfusionist (CCP) led initiative to remove IABP catheters in order to reduce IABP therapy time, hasten removal and improve efficiency. The purpose of the study is to compare outcomes for IABP removal by a certified clinical perfusionist to a physician. The primary outcome measures were site hematoma score and limb related complications. A survey was submitted to bedside nurses, managers/patient care coordinators, CCP's and physicians. The IABP quality assurance database was interrogated for the study. There were 350 patients eligible for inclusion. The cohort was well balanced between CCP (n = 284) and physician (n = 66) groups for patient demographics, indication, insertion specifics and type of medical intervention. The majority of patients had no bruise or hematoma with perfusionist (n = 246, 87%) or physician (n = 58, 88%) (p = 0.78) removal. The physician group demonstrated a higher rate of grade 3 hematomas (p = 0.03). There was no statistically significant difference between CCP and physician groups for limb complications and mortality. Survey results showed an improved efficiency in bed space allocation, physician workload and a decreased IABP support time. There is no difference in limb complications between perfusionist and physician removal of IABP catheters. The survey demonstrate an improvement in resource allocation and efficiency. A perfusionist led IABP removal program can be done safely and may help improve program efficiency.

Temperature management on cardiopulmonary bypass: Is it standardised across Great Britain and Ireland?

Temperature management is an essential element of cardiopulmonary bypass (CPB), as indicated in the Guide to Good Practice in Clinical Perfusion, 'The safe conduct of CPB requires the clinical perfusionist to measure and control. . . blood temperature. . . during the period of bypass'. To review current practice, we have conducted a research survey into the management of temperature on CPB. Surveys were distributed to each centre in Great Britain and the Republic of Ireland, investigating numerous temperature management practices, to elucidate current practice and assess if recent research into temperature management marry routine clinical practice. Our results demonstrate that nasopharyngeal temperature is the most common (52%) temperature site used across the many centres, which correlates with previous research as a routine site for cerebral temperature management. The arterial outlet of the oxygenator temperature was used in 33% of centres, however, all centres lacked the knowledge to maintain this temperature below 37°C. There was significant variation between all centres, especially regarding rewarming times (20-40 minutes), demonstrating a lack of uniformity among perfusion centres. Interestingly, most centres have been using the same protocol that has been in place over the previous 10 years.To conclude, the practice of temperature management is changing with the awareness of new research. Lower target temperatures are recommended for rewarming, ensuring a lower temperature gradient and a longer mean rewarming time.

An evaluation of hard-shell venous reservoir integrated pressure relief valve pressure mitigation performance.

Vacuum assisted venous drainage (VAVD) requires the sealing of the hard-shell venous reservoir, thereby creating circumstances where reservoir pressurization may occur. Manufacturers utilize integrated pressure relief valves (IPRV) to mitigate pressurization risk; however, accidents have been reported even with these devices. We have undertaken a performance evaluation of IPRV's in a large number of hard-shell venous reservoirs. Reservoirs were sealed and gas insufflated while measuring reservoir internal pressure. Linear regression models were developed to depict the association between internal pressure and gas inflow rate. External secondary one-way valves (ESOV) were assessed for pressure mitigation performance. An assisted venous drainage survey was circulated to Canadian Clinical Perfusionists. The reservoirs tested were adult (n = 9, 64%) and pediatric (n = 5, 36%) designs. Significant variability (p < 0.001) in internal reservoir pressures (range: 0.04-161.41 mmHg) was observed across the titrated gas inflow rate (0.5-10.0 l/min). The regression models demonstrate excellent predictive performance (SE: 0.008-0.309). ESOV's reduce the reservoir pressure below that of the IPRV; however, they cannot eliminate reservoir pressurization. The survey showed a majority (91%) of respondents use VAVD, and reservoir pressurization events occur regularly (18%). Significant variability among reservoir's IPRV to mitigate reservoir pressurization exists. The predictive models are extremely accurate at estimating the internal pressure. ESOV performance limitations moderate their utility as a backup pressure mitigation technique. A significant number of reservoir pressurization events are occurring with the use of VAVD. As a result, standardized communication from manufacturers on the purpose and performance of IPRV is recommended in order to delineate the limitations of these devices.

Survey of the Routine Practice Limits for Physiologic and Technical Parameters Managed by Clinical Perfusionists during Adult Cardiopulmonary Bypass.

Cardiopulmonary bypass (CPB) is a highly technical clinical discipline with a recognized variability in practice. Professional standards and guidelines documents help direct clinical practice and reduce variability, but these guidelines are necessarily vague and fall short of providing specific objective recommendations of clinical practice metrics. If clinical practice metrics were known, they would be informative when writing departmental policy manuals, structuring quality improvement initiatives, describing product R&D specifications, and designing educational assessment rubrics. Therefore, to address this gap, we conducted a national survey of clinical practice with the purpose of producing a benchmark of the typical variability of specific technical parameters that are commonly managed during adult CPB procedures. A pool of expert clinical perfusionists collaborated to compile a data set of normal ranges for 41 individual physiologic and technical parameters (pressures, flows, saturation, times, solutions, and temperatures) that are commonly managed during adult CPB procedures. Results were collected using an online survey application. Respondent demographics and measures of central tendency with descriptive quartile statistics and confidence intervals for each parameter are presented. Of the 335 people who participated in the survey, 315 met the inclusion criteria. The geographic demographics of the respondents were representative of the American Board of Cardiovascular Perfusion's distribution of certified clinical perfusionists. Of the 41 parameters investigated, there were 13 hemodynamic parameters, 13 normal flow rates and technical circuit parameters, 10 blood gasses and hematocrit parameters, and five parameters of patient temperatures. The data presented here are informative and provide a consensus-based objective assessment of the standard practice for adult CPB as reported by practicing clinical perfusionists. Based on these survey data, we have identified the typical clinical limits for the 41 parameters that are managed during adult CPB. This information may be incorporated into guiding documents to support the work of clinicians, researchers, and educators.

Survey of the Routine Practice Limits for Physiologic and Technical Parameters Managed by Clinical Perfusionists during Adult Cardiopulmonary Bypass

Cardiopulmonary bypass (CPB) is a highly technical clinical discipline with a recognized variability in practice. Professional standards and guidelines documents help direct clinical practice and reduce variability, but these guidelines are necessarily vague and fall short of providing specific objective recommendations of clinical practice metrics. If clinical practice metrics were known, they would be informative when writing departmental policy manuals, structuring quality improvement initiatives, describing product R&amp;D specifications, and designing educational assessment rubrics. Therefore, to address this gap, we conducted a national survey of clinical practice with the purpose of producing a benchmark of the typical variability of specific technical parameters that are commonly managed during adult CPB procedures. A pool of expert clinical perfusionists collaborated to compile a data set of normal ranges for 41 individual physiologic and technical parameters (pressures, flows, saturation, times, solutions, and temperatures) that are commonly managed during adult CPB procedures. Results were collected using an online survey application. Respondent demographics and measures of central tendency with descriptive quartile statistics and confidence intervals for each parameter are presented. Of the 335 people who participated in the survey, 315 met the inclusion criteria. The geographic demographics of the respondents were representative of the American Board of Cardiovascular Perfusion’s distribution of certified clinical perfusionists. Of the 41 parameters investigated, there were 13 hemodynamic parameters, 13 normal flow rates and technical circuit parameters, 10 blood gasses and hematocrit parameters, and five parameters of patient temperatures. The data presented here are informative and provide a consensus-based objective assessment of the standard practice for adult CPB as reported by practicing clinical perfusionists. Based on these survey data, we have identified the typical clinical limits for the 41 parameters that are managed during adult CPB. This information may be incorporated into guiding documents to support the work of clinicians, researchers, and educators.

The evolving role of the modern perfusionist: insights from transesophageal echocardiography.

Transesophageal echocardiography is a relatively non-invasive, mobile, safe imaging technique that is ideal for providing real-time information on cardiac anatomy and function during heart surgery. The technology has evolved from two-dimensional to real-time three-dimensional imaging during cardiac procedures, which has significantly benefited preoperative planning, intraoperative guidance, evaluation, and postoperative follow-up. Transesophageal echocardiography may serve the clinical perfusionist by providing imaging guidance for identifying potential problems before cardiopulmonary bypass, guiding the proper placement of cannulas, monitoring cardiac performance on cardiopulmonary bypass, and providing useful feedback during weaning from cardiopulmonary bypass. Although the perfusionist should be able to understand all echocardiographic images and measurements in depth, perfusion-related echocardiographic information can or should be used to optimize the clinical practice of the modern perfusionist. Vice versa, whenever the perfusionist suspects a problem, the surgical team including the sonographer should verify this "clinical treat" by echocardiography whenever possible.

Simulation-based training of critical events during cardiopulmonary bypass: importance of a critical events checklist.

Evaluation of critical events training for clinical perfusionists is necessary to improve this educational approach. Critical events checklists are effective in reducing clinical complications, but should be tested in a simulation environment first. Individual behavior and stress response of clinical perfusionists during simulated critical events on cardiopulmonary bypass have not been evaluated yet. This study focuses on the evaluation of critical events training and critical events checklists in simulated cardiopulmonary bypass. A total of 19 clinical perfusionists from a single hospital took part in two simulated critical event scenarios. Clinical perfusionist behavior and physiological responses were recorded using eye tracking, heart rate variability, video, and audio. In addition, workloads were determined and participants were interviewed. Relevant areas of interest were identified for each simulation phase. During critical event detection and subsequent decision-making, areas of interest hits and fixation durations varied with the use of a critical events checklist. Times to decision were shorter, decision quality was higher, and temporal workload was increased when the checklist was used. Evaluation of selected heart rate variability measures revealed a good correlation with pupil diameters. Evaluation of critical events during simulated cardiopulmonary bypass shows that the scenario is realistic and relevant for clinical practice. Integrating a critical events checklist improves the probability of correct decision-making and shortens the correct decision time. Temporal workload is increased when using a checklist. Eye tracking and heart rate variability are well suited to evaluate participants' behaviors and stress levels. All participants welcomed simulation training for critical incidents.

Development of the Adult ECMO Specialist Certification Examination.

The American Society of Extracorporeal Technology Board of Directors, consistent with the American Society of Extracorporeal Technology's safe patient care improvement mission, charged the International Board of Blood Management to write a knowledge and skill certification examination for healthcare personnel employed as adult extracorporeal membrane oxygenation (ECMO) specialists. Nineteen nationally recognized ECMO subject-matter experts were selected to complete the examination development. A job analysis was performed, yielding a job description and examination plan focused on 16 job categories. Multiple-choice test items were created and validated. Qualified ECMO specialists were identified to complete a pilot examination and both pre- and post-examination surveys. The examination item difficulty and candidate performance were ranked and matched using Rasch methodology. Candidates' examination scores were compared with their profession, training, and experience as ECMO specialists. The 120-item pilot examination form ranked 76 ECMO specialist candidates consistent with their licensure, ECMO training, and clinical experience. Forty-three registered nurses, 28 registered respiratory therapists, four certified clinical perfusionists, and one physician assistant completed the pilot examination process. Rasch statistics revealed examination reliability coefficients of .83 for candidates and .88 for test items. Candidates ranked the appropriateness for examination items consistent with the item content, difficulty, and their personal examination score. The pilot examination pass rate was 80%. The completed examination product scheduled for enrollment in March 2020 includes 100 verified test items with an expected pass rate of 84% at a cut score of 67%. The online certification examination based on a verified job analysis provides an extramural assessment that ranks minimally prepared ECMO specialists' knowledge, skills, and abilities (KSA) consistent with safe ECMO patient care and circuit management. It is anticipated that ECMO facilities and ECMO service providers will incorporate the certification examination as part of their process improvement, safety, and quality assurance plans.

Development of the Adult ECMO Specialist Certification Examination

The American Society of Extracorporeal Technology Board of Directors, consistent with the American Society of Extracorporeal Technology’s safe patient care improvement mission, charged the International Board of Blood Management to write a knowledge and skill certification examination for healthcare personnel employed as adult extracorporeal membrane oxygenation (ECMO) specialists. Nineteen nationally recognized ECMO subject-matter experts were selected to complete the examination development. A job analysis was performed, yielding a job description and examination plan focused on 16 job categories. Multiple-choice test items were created and validated. Qualified ECMO specialists were identified to complete a pilot examination and both pre- and post-examination surveys. The examination item difficulty and candidate performance were ranked and matched using Rasch methodology. Candidates’ examination scores were compared with their profession, training, and experience as ECMO specialists. The 120-item pilot examination form ranked 76 ECMO specialist candidates consistent with their licensure, ECMO training, and clinical experience. Forty-three registered nurses, 28 registered respiratory therapists, four certified clinical perfusionists, and one physician assistant completed the pilot examination process. Rasch statistics revealed examination reliability coefficients of .83 for candidates and .88 for test items. Candidates ranked the appropriateness for examination items consistent with the item content, difficulty, and their personal examination score. The pilot examination pass rate was 80%. The completed examination product scheduled for enrollment in March 2020 includes 100 verified test items with an expected pass rate of 84% at a cut score of 67%. The online certification examination based on a verified job analysis provides an extramural assessment that ranks minimally prepared ECMO specialists’ knowledge, skills, and abilities (KSA) consistent with safe ECMO patient care and circuit management. It is anticipated that ECMO facilities and ECMO service providers will incorporate the certification examination as part of their process improvement, safety, and quality assurance plans.

Qualification, knowledge, tasks and responsibilities of the clinical perfusionist in Germany.

Consensus paper of the German Society of Cardiovascular Engineering, the German Society for Thoracic and Cardiovascular Surgery, the German Society of Cardiology, the German Society of Pediatric Cardiology, the German Society of Anesthesiology and Intensive Care Medicine, the German Interdisciplinary Association of Intensive Care Medicine and Emergency Medicine and the German Society of Medical Intensive Care and Emergency Medicine.

A 2015–2016 Survey of American Board of Cardiovascular Perfusion Certified Clinical Perfusionists: Perfusion Profile and Clinical Trends

To document the current perfusion workforce status and to anticipate the future demands of an ever-changing perfusion workplace environment, a valid survey is needed to help guide the future of the perfusion workforce. The American Board of Cardiovascular Perfusion (ABCP) sponsored a survey of Certified Clinical Perfusionist (CCP) demographic and clinical trends that was linked electronically to the 2015–2016 ABCP online recertification process. Of 3,875 eligible CCP’s, 3,056 (78.9%) responded to the survey. The 12 survey questions covered the topics of gender, age, education levels, years of clinical experience, annual clinical activity exposure, high fidelity simulation experience, recertification requirement satisfaction and professional activity requirement contentment. The results of the ABCP annual survey are being published in accordance with the ABCP’s commitment to establish and maintain interactive communication with the community of CCPs. The goal of this survey is to present the perfusion and health-care community with important statistics related to the current field of perfusion and establish trends to guide the future of perfusion.

Impact of Distinct Oxygenators on Pulsatile Energy Indicators in an Adult Cardiopulmonary Bypass Model.

The quantification of pulse energy during cardiopulmonary bypass (CPB) post-oxygenator is required prior to the evaluation of the possible beneficial effects of pulsatile flow on patient outcome. We therefore, evaluated the impact of three distinctive oxygenators on the energy indicators energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE) in an adult CPB model under both pulsatile and laminar flow conditions. The pre- and post-oxygenator pressure and flow were measured at room temperature using a 40% glycerin-water mixture at flow rates of 1, 2, 3, 4, 5, and 6 L/min. The pulse settings at frequencies of 40, 50, 60, 70, and 80 beats per minute were according to the internal algorithm of the Sorin CP5 centrifugal pump. The EEP is equal to the mean pressure, hence no SHE is present under laminar flow conditions. The Quadrox-i Adult oxygenator was associated with the highest preservation of pulsatile energy irrespective of flow rates. The low pressure drop-high compliant Quadrox-i Adult oxygenator shows the best SHE performance at flow rates of 5 and 6 L/min, while the intermediate pressure drop-low compliant Fusion oxygenator and the high pressure drop-low compliant Inspire 8F oxygenator behave optimally at flow rates of 5 L/min and up to 4 L/min, respectively. In conclusion, our findings contributed to studies focusing on SHE values post-oxygenator as well as post-cannula in clinical practice. In addition, our findings may give guidance to the clinical perfusionist for oxygenator selection prior to pulsatile CPB based on the calculated flow rate for the individual patient.

Results of the 2015 Perfusionist Salary Study

Presently, there exists no published valid and reliable salary study of clinical perfusionists. The objective of the 2015 Perfusionist Salary Study was to gather verifiable employee information to determine current compensation market rates (salary averages) of clinical perfusionists working in the United States. A salary survey was conducted between April 2015 and March 2016. The survey required perfusionists to answer questions about work volume, scheduling, and employer-paid compensation including benefits. Participants were also required to submit a de-identified pay stub to validate the income they reported. Descriptive statistics were calculated for all survey questions (e.g., percentages, means, and ranges). The study procured 481 responses, of which 287 were validated (i.e., respondents provided income verification that matched reported earnings). Variables that were examined within the validated sample population include job title, type of institution of employment, education level, years of experience, and geographic region, among others. Additional forms of compensation which may affect base compensation rates were also calculated including benefits, call time, bonuses, and pay for ancillary services (e.g., extracorporeal membrane oxygenation and ventricular assist device). In conclusion, in 2015, the average salary for all perfusionists is $127,600 with 19 years' experience. This research explores the average salary within subpopulations based on other factors such as position role, employer type, and geography. Information from this study is presented to guide employer compensation programs and suggests the need for further study in consideration of attrition rates and generational changes (i.e., perfusionists reaching retirement age) occurring alongside the present perfusionist staffing shortage affecting many parts of the country.

Vacuum-Assisted Venous Drainage: A 2014 Safety Survey

Despite the widespread use of vacuum-assisted venous drainage (VAVD) and case reports describing catastrophic incidents related to VAVD, there is a lack of data cataloging specific safety measures that individuals and institutions have incorporated into their VAVD practices for the prevention of these incidents. Therefore, the purpose of this study is to survey the perfusion community to gather data on VAVD practices, and to compare these current practices with literature recommendations and the American Society of ExtraCorporeal Technology (AmSECT) Standards and Guidelines. In September 2014, a survey was distributed via PerfList and PerfMail, and by direct e-mail to members of the New York State Society of Perfusionists, targeting certified clinical perfusionists in New York State. Survey topics pertaining to VAVD practice included 1) equipment, 2) pressure monitoring and alarms, 3) protocols, checklists, and documentation, and 4) VAVD-related incidents. Of ∼200 certified clinical perfusionists who live and/or work in New York State (NYS), 88 responded (42%). Most respondents (90.1%) report they use VAVD. Of these, 87.3% report that they monitor VAVD pressure, with 51.6% having audible and visual alarms for both positive and excessive negative pressures. At the institutional level, 61.2% of respondents reported that there is a protocol in place at for their team limiting negative pressure in the reservoir, 28.4% document VAVD pressure in the pump record, and AmSECT’s three recommended VAVD checklist items are met with 53.7%, 55.1%, and 33.8% compliance. In conclusion, the results of this study reveal that the use of VAVD has increased and has become nearly universal in 2014. There is high compliance to some of the literature recommendations and AmSECT Standards and Guidelines, however, there are still some gaps between current practices and these recommendations. Continued improvement, both at the individual and institutional levels, will help to improve patient safety by preventing untoward events from occurring while using VAVD.

Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass

Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A total of 52 adult patients who underwent cardiac surgery using pulsatile CPB were included in this prospective explorative study. Cerebral tissue oxygen saturation (SctO2) was measured in both the left and right cerebral hemisphere. Intraoperative events, involving interventions performed by anesthesiologist, surgeon, and clinical perfusionist, were documented. Simultaneously, in-line hemodynamic parameters (partial oxygen pressure, partial carbon dioxide pressure, hematocrit, arterial blood pressure, and CPB flow rates) were recorded. Cerebral tissue saturation was affected by anesthetic induction (p &lt; .001), placement of the sternal retractor (p &lt; .001), and initiation (p &lt; .001) as well as termination of CPB (p &lt; .001). Placement (p &lt; .001) and removal of the aortic cross-clamp (p = .026 for left hemisphere, p = .048 for right hemisphere) led to changes in cerebral tissue saturation. In addition, when placing the aortic cross-clamp, hematocrit (p &lt; .001) as well as arterial (p = .007) and venous (p &lt; .001) partial oxygen pressures changed. Cerebral tissue oximetry effectively identifies changes related to surgical events or vulnerable periods during cardiac surgery. Future studies are needed to identify methods of mitigating periods of reduced cerebral saturation.

SIMULATED TEAM-BASED CPB EMERGENCY PREPAREDNESS TRAINING

s S237 upon their lived experiences during a realistic but riskfree environment. Additionally, these exercises serve as an ice-breaker that helps dissolve preconceived notions and expectations of interprofessional relationships. The benefits of offering this type of training with simulated exercises to existing surgical teams may also realize similar improvements. 357 SECONDARY PREVENTION AFTER CORONARY ARTERY BYPASS GRAFT SURGERY: PRESENTATION OF A SCIENTIFIC STATEMENT